Job Description

Job Description:

Job Title: Clinical Pharmacist 1

Assignment Duration: 3 Months (Possible Extensions)

Location: Remote
Working Hours: 9am 6pm EST Mon-Fri

Position Summary:
The Clinical Pharmacist is responsible for reviewing and analyzing prior authorization and pharmacy claims requests to determine medical necessity, appropriateness, and formulary compliance. This role supports quality, cost-effective healthcare delivery and ensures timely resolution of service authorization requests while collaborating with healthcare providers, pharmacy technicians, and internal teams.

Key Responsibilities:

• Review and evaluate pharmacy prior authorization requests and recommended denials to determine appropriateness of therapy using clinical judgment and evidence-based guidelines.

• Verify member eligibility, prescription benefit coverage, and health plan benefit information.

• Evaluate prescription claim history, laboratory results, chart notes, and provider specialty as necessary.

• Apply medical policy criteria, professional clinical judgment, and formulary guidelines to approve or deny requests.

• Draft criteria and recommendations for non-formulary medication requests.

• Communicate with providers regarding prior authorization status, plan benefits, quantity limits, age restrictions, formulary alternatives, and clinical guidance.

• Research and provide clinical drug information to providers and pharmacy staff to support safe and effective medication management.

• Compile data for reporting purposes, including non-formulary utilization, overturned denials, high-cost claims, and formulary recommendations.

• Support pharmacy committee decisions and initiatives, including national P&T committees or formulary updates.

• Maintain accurate documentation of all review activities and ensure compliance with regulatory, legal, and organizational standards.

• Participate in process improvement initiatives and contribute to a collaborative, learning-oriented team environment.

Required Qualifications:

• Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy.

• Active pharmacist license in good standing with any U.S. state or ability to obtain licensure in the required state within 6 months.

• 0 2 years of professional pharmacy experience.

• Proficiency with Microsoft Office applications and accurate data entry.

• Strong sense of urgency, accountability, and attention to detail.

Preferred Qualifications:

• Experience in managed care, health plan, or clinical pharmacy environments.

• Knowledge of Medicare and Medicaid regulations.

• Typing speed of 50+ WPM.

• Experience with pre-service, concurrent, or post-service authorization review.

Performance Expectations:

• Review an average of 85 100 cases daily with high accuracy.

• Demonstrate professionalism, independent decision-making, and efficiency in a fast-paced environment.

• Collaborate effectively with a supportive and cross-functional team.

Work Environment:

• Remote work within the assigned time zone.

• Fast-paced, dynamic workflow with opportunities to enhance clinical decision-making and problem-solving skills.

Key Attributes for Success:

• Self-motivated with strong time management skills.

• Goal-oriented and able to prioritize multiple tasks.

• Strong communication and collaboration skills.

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