Clinical Review Pharmacist (Fully Remote)
12 month Contract role with potential to go permanent
Fully remote for now possible but possibility to turn Hybrid in office 2 days a week in Durham come January 2027 MUST live within a commutable distance to Durham
M-F 9-5 EST hours, can live in other time zones but work those EST hours
ā¢ Call Center, PBM, or Retail experience
ā¢ Must have an understanding of Medicare STARS and Metrics
ā¢ Must be comfortable on the phones interacting with members
ā¢ Review prior authorization requests and make determinations for drug products according to member benefits and coverage criteria
ā¢ Report to utilization review statistics to corporate compliance committees
ā¢ Review data and summarize daily utilization review numbers
ā¢ Responsible for tracking compliance of review cases
ā¢ Provide clinical guidance and support to the assigned pharmacy technicians
ā¢ Knowledge of drug coding (NDC, GCN, GPI and USC) and NCPDP claims adjudication systems
ā¢ Review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design.
ā¢ Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices
ā¢ Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
Hiring Requirements
ā¢ Bachelor's degree or advanced degree
ā¢ 3+ years of experience in related field.
ā¢ Current states pharmacy license.
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Apply To this Job
Fully remote for now possible but possibility to turn Hybrid in office 2 days a week in Durham come January 2027 MUST live within a commutable distance to Durham
M-F 9-5 EST hours, can live in other time zones but work those EST hours
ā¢ Call Center, PBM, or Retail experience
ā¢ Must have an understanding of Medicare STARS and Metrics
ā¢ Must be comfortable on the phones interacting with members
ā¢ Review prior authorization requests and make determinations for drug products according to member benefits and coverage criteria
ā¢ Report to utilization review statistics to corporate compliance committees
ā¢ Review data and summarize daily utilization review numbers
ā¢ Responsible for tracking compliance of review cases
ā¢ Provide clinical guidance and support to the assigned pharmacy technicians
ā¢ Knowledge of drug coding (NDC, GCN, GPI and USC) and NCPDP claims adjudication systems
ā¢ Review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design.
ā¢ Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices
ā¢ Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
Hiring Requirements
ā¢ Bachelor's degree or advanced degree
ā¢ 3+ years of experience in related field.
ā¢ Current states pharmacy license.
Apply tot his job
Apply To this Job