Title: Clinical Pharmacist
This role is a remote/virtual role.
Top 3 Skills Needed:
UM Review experience, Community Pharmacy background and 3-6 years of pharmacy experience.
Retail Pharmacy experience is more beneficial over clinical.
The expected volume is 35 to 40 cases daily
Job Description:
• Review prior authorization requests and make determinations for drug products according to member benefits and coverage criteria
• Report to utilization review statistics to corporate compliance committees
• Review data and summarize daily utilization review numbers
• Responsible for tracking compliance of review cases
• Provide clinical guidance and support to the assigned pharmacy technicians
• Knowledge of drug coding (NDC, GCN, GPI and USC) and NCPDP claims adjudication systems
• Review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design.
• Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices
• Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
Hiring Requirement
• Bachelor's degree or advanced degree
• 3+ years of experience in related field.
• Current states pharmacy license.