*Pharmacist - Clinical Pharmacist

CTC

Job Summary (List Format):

- 100% remote, work-from-home position
- Responsible for reviewing and resolving Medicare-Medicaid coverage determination/redetermination requests
- Conduct clinical reviews for coverage determinations, redeterminations, and global exceptions
- Review and process requests not clearly approvable based on established criteria
- Monitor and improve the quality and efficiency of the prior authorization process
- Draft and review denial language and communicate with prescribers and members as needed
- Recommend medication regimen improvements to physicians
- Collaborate with the coverage determination pharmacy team on process improvement initiatives
- Complete all required annual NCQA training
- Respond to pharmacy-related inquiries from internal teams and member services
- Maintain communication with other departments and functional areas
- Stay updated on the latest clinical literature and guidelines and share with program development teams
- Requires a Pharm D. degree and an active, unrestricted pharmacy license in the resident state
- Previous clinical pharmacy and prior authorization experience preferred
- Must possess basic computer skills and strong organizational, interpersonal, and detail-oriented abilities
- Standard work schedule: Monday Friday, 9:00 AM 5:30 PM

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Vacancy posted 3 days ago

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