Title: Clinical Pharmacist
Duration: 10 months
Location: The role is 100% remote, but candidates need to be from an approved conversion State (Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.)
Shift Timing: M-F 8am - 5pm

Job Description:

• Engage Medicare members, pharmacies, and providers to close adherence and SUPD (Statin Use in Persons with Diabetes) gaps. Complete Comprehensive Medication Reviews (CMRs) with Medicare members.
• Make outreach to Medicare members to assist in removing barriers to medication adherence.
• Partner with pharmacies and providers to close adherence gaps when the Medicare member is unengaged or when the Medicare member requires assistance.
• Contact providers to close SUPD (Statin Use in Persons with Diabetes) gaps.
• Complete Comprehensive Medication Reviews (CMRs) with eligible Medicare members to give the member a better understanding of their medications and health.   
• Send interventions to providers through fax or the CMR platform to alert the provider of potential drug interactions and adverse reactions, dose changes, adherence issues, etc.
• Provide counseling to Medicare members regarding medications.
• Provide Medicare members with information regarding their pharmacy benefits (ie. formulary, preferred pharmacy, supplemental benefits, etc.)
• Provide clinical guidance and support to the Pharmacy Quality Specialists.
• 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.

Hiring Requirements:

• Bachelor's degree or advanced degree.
• 3+ years of experience in related field.
• Current states pharmacy license.

Top 3-4 Required Skills:

• Able to work on computers and has work from home experience.
• Pharmacist experience.

Nice to have Skills:

• Medicare and medicaid experience.
• Health Plan 
• Managed care experience

Years of Experience:

• 3-5

Education/Certifications Required:

• Pharmacist license for the state.

Industry Specific Experience – required, ideal, necessary?

• Retail, HMO, DSP

Breakdown of Duties/Typical Day:

• Participating in comprehensive medication review.
• Cold calling members and reaching out on non adherence. 

Do you have screening questions?

• Do you have any familiarity with Medicare STARs and metrics? If so, please explain.

 
 
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: $ 61.80/hr.