Description
Title: Clinical Pharmacist Duration: 12 months Location: The role is 100% remote, but candidates need to 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.) Shift Timing: M-F 8-5 EST Job Description: 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. Hiring Requirements: Bachelor's degree or advanced degree. 3+ years of experience in related field. Current states pharmacy license. Top 3-4 Required Skills: Able to work on computers and has work from home experience. Pharmacist experience. High volume call. Nice to have Skills: Medicare and Medicaid experience. Health Plan. Retail experience. Years of Experience: 3-5 Education/Certifications Required: Pharmacist license for the state. Industry Specific Experience – required, ideal, necessary? Retail, HMO, DSP What is this role’s main focus for the 1st 90 days? Training then getting into the action of the role. Breakdown of Duties/Typical Day: Comprehensive case review focusing on CMRs. 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 inbounding calls. Calls will be recorded and audited for quality check. What are the team’s biggest priorities over the next 6-12 months? Working with the case managers and members to bring comprehensive care. What does the training look like for this role? Training starts on 8/24, virtual training. Two week training and observe case managers to get the lay of the land. Then they will do on the job training. Do you have screening questions? Have you had any experience with compliance work where you had timelines to meet? If so, please explain. Applicant Notices & Disclaimers For information on benefits, equal opportunity employment, and location-specific applicant notices, click here