Title: Clinical Pharmacist 1 
Duration: 6 months possible extension
Location: Remote (Preferred NC, AZ, KS, TX, IN, GA, NJ, CA, FL)
Schedule: 8 hour shift (typically 9am-5:30pm in worker’s timezone)

Job Decsription:
• 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

• Purpose: Primary duty for this position is to review prior authorization requests for medical benefit (buy and bill) drugs requests across the Medicare, Medicaid, Exchange, and Commercial lines of business
• This position is fully remote. We prefer a candidate with strong clinical skills, drug knowledge, and managed care experience in prior authorization review. We expect a candidate that embodies Centene culture.
• Accountability: Setting clear goals, being transparent about outcomes, and inviting feedback to foster growth. 
• Courage: Pushing past fear and uncertainty to make the best possible decisions.
• Curiosity: Approaching every interaction as an opportunity to learn.
• Trust: Demonstrating integrity, honesty, and vulnerability to build strong relationships.
• Service: Focusing our work through the lens of our mission.
• This request is a temp backfill position for a permanent rec (recent pharmacist promotion). This position is eligible for temp to perm
• •Our department receives and reviews prior authorization requests for medical benefit (buy and bill) drugs requests across the Medicare, Medicaid, Exchange, and Commercial lines of business
  •They will be required to review the doctor’s request based on defined criteria to determine if the medication can be approved or denied.
  •The RFS production goal is 90%. This goal should be met daily and monthly. This goal roughly averages to 47 cases completed per day.
  The quality goal is 99.9%.

Education/Certification	Required: Bachelor’s or Doctorate of Pharmacy degree.			Preferred:
Licensure	Required: Current state’s Pharmacist license with no restrictions.			Preferred: Pharmacist Licenses we required based on business needs: NC AZ KS TX              IN              GA NJ CA FL
Years of experience required: 1+ years of retail, hospital, managed care, or PBM experience. Previous experience with reviewing prior authorizations for a managed care organization/PBM.   Disqualifiers:   Additional qualities to look for: Preferred experience with outlook, teams, SharePoint, excel
Top 3 must-have hard skills stack-ranked by importance		1	Decisive clinical decision making
		2	Flexibility/adaptability
		3	Quick learner

  
 
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 $58.00/hr - $61.00/hr.