Clinical Pharmacist
Job Title: Clinical Pharmacist Location: Remote NC Duration: 12 Months Basic Information Hours per week: 40 Shift/Work Schedule: M-F 8-5 EST Job Description & 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 Breakdown of Duties / Typical Day They will review the medicine that a customer is on and help them be able to review the medicine a customer is having. They will be making outbound as well as inbound calls. Calls will be recorded and audited for quality check. Looking for open care gaps. Clinical review, prior authorization, ad-hoc tasks. Hiring Requirements Education/Certifications Required: Bachelor's degree or advanced degree; Current state pharmacy license. Years of Experience: 3-5 years (3+ years of experience in related field) Industry Specific Experience: Retail, HMO, DSP Talent Value Proposition Top 3-4 Required Skills: Able to work on computers and has work from home experience Pharmacist experience
Nice-to-Have
Skills: Medicare and managed care.