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.