Clinical - Clinical Pharmacist 1 - 210392

Job Title: Clinical Pharmacist

Location: Remote - EST
Duration: 3 Months
Schedule: 1st Shift, 9:00 AM 6:00 PM EST | No OT

Pay: $65/hour

Job description

Responsibilities

• Review completed prior authorization requests received from providers and/or pharmacy technician-recommended denials, including suggested formulary alternatives, comments, and attachments for appropriateness.
• Verify member ID number and date of birth.
• Verify member eligibility through the appropriate health plan eligibility system.
• Record carrier and group number, when applicable.
• Check for previous prior authorization decisions.
• Verify prescription benefit coverage when necessary.
• Verify health plan benefit coverage when necessary.
• Evaluate prescription claim history.
• Review chart notes and/or laboratory values.
• Identify provider specialty when appropriate.
• Apply Medical Policy Criteria to prior authorization requests.
• Evaluate whether requests meet criteria for approval.
• Review requests using professional clinical judgment on a case-by-case basis.
• Review medication requests not addressed by P&T Committee criteria or guidelines, and develop and draft criteria for requested non-formulary medications.
• Research and contribute drug references and clinical information to facilitate prior authorization reviews.
• Provide clinical information directly to physicians via fax or phone encounter, or to pharmacy technicians via memo or as an educational resource.

Physician Communication

• Communicate with physicians regarding prior authorization requests involving:
• Non-formulary drugs
• Plan benefits and exclusions
• Quantity limits
• Age restrictions
• Formulary alternatives

Data and Reporting

• Retrieve and collect data through available reporting resources,
• Compile data for reporting purposes, including:
• Drug utilization of non-formulary drugs
• Overturned IPS recommended denials
• Audit of pharmacy claims
• Suggestions for addition or deletion of drugs to/from the formulary
• Updating quantity/days or age limit ends
• Support for the National P&T Committee
• Other tasks that may arise during the performance of the above-mentioned duties

Skills:-

• Self-Motivated/Good Time Management Skills
• Working Knowledge of Office Suite
• Goal Oriented

Qualifications

• PharmD (Required)
• Current Pharmacist license
• At least one year of professional RPh experience
• Some experience working in managed care, understanding of Medicare/Medicaid law (Nice to have)

Certifications & Licenses:

• Pharmacist license (Any US state)