Clinical Pharmacist 1

Job Title

Work Mode: 100% Remote Duration: 3 months Shift: 9am – 6pm EST, No OT

Responsibilities

Review completed prior authorization requests from providers and pharmacy technician recommendations.

Verify member's ID number, date of birth, and eligibility in the health plan system.

Record carrier and group numbers if applicable and check for previous authorization decisions.

Verify coverage in prescription and health plan benefits when necessary.

Evaluate prescription claim history and review chart notes or lab values.

Identify provider specialty when appropriate and apply Medical Policy Criteria to requests.

Evaluate whether requests meet criteria for approval using professional clinical judgment.

Research and contribute drug references and clinical information for authorization review.

Communicate with physicians regarding non-formulary drugs and plan benefits.

Retrieve and compile data for reporting purposes, including drug utilization and audit pharmacy claims.

Requirements

Pharm D. required.

Any US state licensure required.

At least one year of professional RPh experience.

Preferred Skills

Self-motivated and metric-driven.

Easily adaptable to frequent change.

Experience with systems such as MHK, Micromedex, AHFS.

Minimal gaps in employment history.

Licensure in WA, GA, FL, IN, NC, and NH could be a plus.

Some experience in managed care and understanding of Medicare/Medicaid law.

Performance Indicators

Sign 85 – 100 cases daily.