Position Title: Clinical Pharmacist 1
Work Location: Remote
Assignment Duration: 3 months
Work Schedule: 9am – 6pm EST 

Responsibilities:
•    Reviews a completed prior authorization request received from the provider and/or reviews the pharmacy technician’s recommended denial, suggested formulary alternatives, comments and attachments for appropriateness.
•    Verifies member’s ID number and date of birth.
•    Verifies member’s eligibility in the appropriate health plan eligibility system.
•    Records carrier and group number if applicable.
•    Checks for previous prior authorization decisions.
•    Verifies coverage in member’s prescription benefit when necessary.
•    Verifies coverage in member’s health plan benefit when necessary.
•    Evaluates prescription claim history.
•    Reviews chart notes and/or lab values.
•    Identifies provider specialty when appropriate.
•    Applies Medical Policy Criteria to prior authorization requests.
•    Evaluates whether request meets criteria for approval.
•    Reviews the request using professional clinical judgment on a case by case basis. A pharmacist will review medication requests not addressed by P&T Committee criteria or guidelines, develop and draft criteria for the non-formulary medication requested.
•    Researches and contributes drug references and clinical information to facilitate prior authorization review: directly to physicians via fax or phone encounter; or to pharmacy technicians via memo or on a personal level as an educational tool
•    Communicates with physicians regarding prior authorization:
o    For a non-formulary drug
o    Plan benefits, exclusions
o    Quantity limits
o    Age restrictions
o    Formulary alternatives
•    Retrieves and collects data through available reporting resources (i.e. Discoverer, IT Department)
•    Compiles data for reporting purposes:
o    Drug utilization of non-formulary drugs
o    Overturned IPS recommended denials
o    Audit pharmacy claims greater than $200.00
o    Suggest addition or deletion of drugs to/from the formulary
o    Updating qty/days or age limit ends
o    Support National P&T Committee
 

Candidate Requirements
Required: Pharm D.		Preferred: n/a
Required: Any US state		Preferred: n/a
Must haves: At least one year of professional RPh experience   Nice to haves: Some experience working in managed care, understanding of Medicare/Medicaid law   Disqualifiers: n/a   Performance indicators: •       Sign 85 – 100 cases daily
1	Self-Motivated/Good Time Management Skills
2	Working Knowledge of Office Suite
3	Goal Oriented

 
 
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $ 58.00/hr.