Clinical Pharmacist

Overview

Position Title: Clinical Pharmacist 1

Work Location: Remote - NC and CA

Assignment Duration: 06 months, possible temp to hire

Work Schedule: 8-hour shift (typically 9:00 AM - 5:30 PM in worker's time zone)

Work Arrangement: Remote

Define and develop standard and custom formularies for assigned plans. Primary duty is reviewing prior authorization requests for medical benefit (buy-and-bill) drugs across multiple lines of business.

This is a temporary backfill role supporting pharmacy services with responsibility for prior authorization reviews across Medicare, Medicaid, Exchange, and Commercial plans.

• Develop clinical criteria for medications, recommend plan design changes, and clinical programs to be initiated
• Monitor prior authorization requests
• Provide clinical support to internal departments and address clinical-related questions
• Ensure appropriate quality controls and initiate opportunities for performance improvement in pharmacy practice
• Develop and implement programs designed to impact DUR for both Medicaid and Medicare
• Develop, implement, and maintain policies and procedures for the pharmacy department
• Participate in the coordination of the Medicare MTM program
• Assist case management team with members, including clinical rounds presentations
• Review physician requests for medical benefit (buy-and-bill) drugs and determine approval or denial based on defined criteria

• Required: Bachelor’s or Doctorate of Pharmacy degree.
• Preferred:

• Required: Current state's Pharmacist license with no restrictions.
• Preferred: Pharmacist Licenses ranked by priority:
• NC
• CA
• NJ
• AZ
• KS
• TX
• IN
• GA

Years of experience: 1+ years of retail, hospital, managed care, or PBM experience. Previous experience with reviewing prior authorizations.

Disqualifiers:

Additional qualities: Preferred experience with Outlook, Teams, SharePoint, Excel

Preferred:
Pharmacist Licenses ranked by priority (see above).