Clinical - Clinical Pharmacist 1 - 210392

Clinical Pharmacist I

Duration: Contract (3 Months) Location: Remote Schedule: Monday Friday | 9:00 AM 6:00 PM EST Pay Range: $60 - 65/hourly

Job Summary: We are hiring a Clinical Pharmacist I to join a remote Pharmacy Appeals team. In this role, you will review prior authorization and appeal requests to help ensure members receive the right medications based on clinical guidelines and health plan policies. You will work with healthcare providers, pharmacy technicians, and internal teams to make accurate and timely coverage decisions.

Key Responsibilities

• Review prior authorization and appeal requests for prescription medications.
• Evaluate clinical information, medical records, and pharmacy claims.
• Review pharmacy technician recommendations and make final clinical decisions.
• Verify member eligibility and prescription benefits.
• Apply clinical guidelines and health plan policies when reviewing requests.
• Communicate with healthcare providers regarding medication coverage, formulary alternatives, and prior authorization decisions.
• Review non-formulary medication requests and provide clinical recommendations.
• Research drug information and use clinical resources to support decisions.
• Assist with formulary updates and pharmacy reports when needed.
• Maintain accurate documentation and follow company, state, and federal pharmacy regulations.
• Meet daily productivity and quality goals.

Required Qualifications

• Doctor of Pharmacy (PharmD) degree.
• Active Pharmacist (RPh) license in good standing in any U.S. state.
• At least 1 year of pharmacist experience.
• Strong clinical knowledge and attention to detail.
• Good communication and organizational skills.
• Ability to work independently in a remote environment.
• Basic knowledge of Microsoft Office.

Preferred Qualifications

• Experience in managed care, health plans, or pharmacy benefit management (PBM).
• Knowledge of Medicare and Medicaid guidelines.
• Experience with prior authorization or pharmacy appeals.

Required Skills

• Clinical pharmacy knowledge
• Prior authorization review
• Medication evaluation
• Clinical decision-making
• Time management
• Communication skills
• Microsoft Office
• Attention to detail
• Organization
• Problem-solving

Performance Expectations

• Review 85100 cases per day while maintaining quality and accuracy.
• Complete reviews within required turnaround times.
• Make clear and accurate clinical decisions based on guidelines.