Clinical Pharmacist
Select Source International
Job Title: Clinical Pharmacist
Location: Remote NC
Duration: 12 Months
Basic Information
- Hours per week: 40
- Shift/Work Schedule: M-F 8-5 EST
Job Description & Responsibilities
- 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
Breakdown of Duties / Typical Day
- They will review the medicine that a customer is on and help them be able to review the medicine a customer is having.
- They will be making outbound as well as inbound calls.
- Calls will be recorded and audited for quality check.
- Looking for open care gaps.
- Clinical review, prior authorization, ad-hoc tasks.
Hiring Requirements
- Education/Certifications Required: Bachelor's degree or advanced degree; Current state pharmacy license.
- Years of Experience: 3-5 years (3+ years of experience in related field)
- Industry Specific Experience: Retail, HMO, DSP
Talent Value Proposition
- Top 3-4 Required Skills:
- Able to work on computers and has work from home experience
- Pharmacist experience
- Nice-to-Have Skills: Medicare and managed care.
Vacancy posted 4 days ago
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