Clinical Pharmacist

Pharmacy Reviewer

This role serves as a reviewer of prior authorizations.

Primary duties and responsibilities:

• Review and render decisions on authorizations and appeals for specialty, non-specialty, and physician administered drugs
• Conduct peer-to-peer calls with prescribers to discuss the clinical rationale of adverse determinations
• Participate in clinical quality audits and inter-rater reliability testing
• Provide internal team support for escalations and questions
• Apply clinical expertise to ensure appropriate and safe use of pharmaceuticals by members and providers
• Compliance with all applicable laws and regulations
• Other duties as assigned

Required experience and education:

• Doctor of Pharmacy Degree
• Active, unrestricted pharmacist license
• 3+ years of experience as a licensed pharmacist
• Willingness to obtain licensure/training with new states, as needed

Preferred experience and education:

• 3+ years of experience performing clinical review in a managed care setting and experience writing clinical criteria
• Strong clinical skills and experience applying clinical criteria in clinical review setting
• Board Certification (i.e. BCPS, BCOP)
• Residency training
• Experience practicing pharmacy in a clinical setting (i.e. retail, hospital, specialty, etc.)

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender, identity, national origin, disability, or protected veteran status.