Position Title: Clinical Pharmacist 1
Work Location: Remote 
Assignment Duration: 3 Months
Work Schedule: 9am – 6pm EST No OT
Work Arrangement: Remote

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.
•    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
 

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		Ideal candidates are:   Self-motivated Metric driven (retail experience can be an indicator of this but not always) ---what are the metric goals in their current role?  How many cases per day do they complete? ---this is crucial information if they are working in a prior auth role or have worked prior auth before Easily adaptable to frequent change Any previous Centene experience or experience with our systems (MHK, ESI, Micromedex, AHFS to name a few) Minimal gaps in employment history Licensure in the following states COULD be a plus –  WA, GA, Fl, IN, NC, and NH? Also, it is very helpful to see any metrics that the candidate was held to in previous positions (ie case load numbers   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 pay range is $55.00/hr - $60.00/hr.