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Position Title: Clinical Pharmacist
Work Location: 100% remote.
Candidates must 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.)
Assignment Duration: 12 months
Work Schedule: Mon - Fri 8 am - 5 pm Eastern Time
Work Arrangement: Remote
*Candidate can be from approved states but need NC pharmacist license only.*
Screening Q. Have you had any experience with compliance work where you had timelines to meet? If so, please explain.
Position Summary: 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.
Background & Context: Role supports pharmacy benefit operations and Pharmacy and Therapeutics Committee functions within our organization.
Key Responsibilities:
• 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
Qualification & Experience:
• Bachelor's degree or advanced degree
• 3+ years of experience in related field.
• Current states pharmacy license.
• Able to work on computers and has work from home experience
• Pharmacist experience
Working Conditions & Physical Demands (If Applicable): None explicitly stated beyond standard remote computer-based work.
Additional Information (If Applicable):
Training consists of 6 weeks of direct 1-1 training.
Group based for topics, then split out to pharmacists to work the case with you.
Day-to-day involves reviewing the medicine that a customer is on, outbound as well as inbound calls (calls will be recorded and audited for quality check), looking for open care gaps, clinical review, prior authorization, and adhoc tasks.
Nice to have: Medicare and managed care