Position Title: Clinical Pharmacist 1

Work Location: Remote

Assignment Duration:  3 Months with a potential for extension or conversion 

Work Schedule: 9am – 6pm EST , OT possible

Job Description:
• 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.
Develop clinical criteria for medications, recommend plan design changes, and clinical programs to be initiated
• Monitor prior authorization requests
• Provide clinical support to internal departments and address clinical related questions
• Ensure appropriate quality controls and initiates opportunities for performance improvement in pharmacy/practice
• Develop and implement programs designed to impact DUR for both Medicaid and Medicare
• Develop, implement, and maintain policies and procedures for the pharmacy department
• Participate in the coordination of the Medicare MTM program
• Assist case management team with members including clinical rounds presentations
•    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

Candidate Requirements
Education/Certification	Required: Pharm D.			Preferred: n/a
Licensure	Required: Any US state			Preferred: n/a
Years of experience required Disqualifiers Best vs. average Performance indicators		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
Top 3 must-have hard skills Level of experience with each Stack-ranked by importance Candidate Review & Selection		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: $ 57.00/hr.