Clinical Review Pharmacist

About the Role We’re unique. You should be, too. We’re changing lives every day for both our patients and our team members. Are you innovative, entrepreneurial, and hardworking? We need great people to join our team. The Clinical Review Pharmacist ensures that members have access to medically necessary prescription drugs used in a cost‑effective, safe manner. This role completes prior authorizations for internal expert peer discussions on high‑cost medications, participates in formulary management, clinical pharmacy services, and performance metrics oversight. Essential Job Duties and Responsibilities Reviews coverage determinations and appeals in a timely, compliant, and accurate manner. Ensures compliance with the coverage determination and appeals process. Acts as a liaison between ChenMed and patients with respect to clinical guidelines. Serves as the formulary expert for the therapeutic class being reviewed. Contributes to projects aimed at improving STAR ratings, HEDIS, CAHPS, and other quality metrics. Assists with clinical questions and phone calls from prescribers, pharmacies, and members. Develops, implements, and maintains pharmacy cost control and quality initiatives under leadership guidelines. Monitors drug utilization and assists leadership in understanding quality and cost control issues. Acts as liaison concerning pharmacy benefits. Works with providers to ensure accurate coverage determination decisions. Performs outreach to patients and providers as part of quality and cost control initiatives. Performs other duties as assigned and modified at manager's discretion. Knowledge, Skills and Abilities Excellent analytical and deductive reasoning skills; detail oriented. Good judgment and problem‑solving skills. Knowledge of state and federal insurance programs. Familiarity with local, state, and federal pharmacy laws and regulations. Ability to work independently and as part of a team. Effective communication with staff, management, executives, and patients/members. Strong organization and time‑management skills and ability to multitask. Written and verbal fluency in English; bilingual preferred. Proficiency with Microsoft Office (Outlook, Excel, Word, PowerPoint). Willingness to travel locally up to 50% and work evenings, weekends, or holidays as needed. Requires independent judgment. Education and Experience Criteria Doctorate of Pharmacy (PharmD) required. License in good standing. Minimum one year of pharmacy experience. Preferred: one year of utilization review experience, residency training, managed‑care experience, Medicare Part D or Medicaid experience. Pay Range $118,062 – $168,658 salary. Final compensation depends on experience, education, location, and other factors. Position may be eligible for bonuses or commissions. Employee Benefits #J-18808-Ljbffr JobRx, Inc.