100% Remote // Pharmacist Reviewer (Clinical Coding, Claims)

100% Remote Pharmacist Reviewer (Clinical Coding, Claims) Contract Job Description: Required skills: Active US license as a Pharmacist. Minimum of 5 years experience as a Pharmacist, with a minimum of 3 years experience in hospital pharmacy required. Experience in managed care, clinical coding and clinical authorization or claims review. Experience researching drugs for application and exceptions. Strong IT skills- able to work in different systems. Mandatory Skills Active US Pharmacist license (mandatory) 5+ years overall experience with 3+ years in hospital pharmacy, Strong clinical foundation in medication management Experience in managed care and clinical authorization, claims review and clinical coding Strong expertise in drug research, usage, and exceptions, Ability to evaluate formulary and non-formulary cases Proficient in multiple healthcare systems/tools Nice To have Skills Knowledge of payer guidelines and approvals, utilization management processes Experience in prior authorization workflows Communication, Collaboration, Articulation & Attitude Show more Show less