Clinical Pharmacist

Job Title: Clinical Pharmacist Duration: 6 months Contract (Possibility to extend or Convert to FTE based on business needs) Location: Remote Schedule: 8-hour shift (typically 9-530pm in worker’s time zone) payrate: $58-62/hr Duties: This position is fully remote. Primary duty for this position is to review prior authorization requests for medical benefit (buy and bill) drugs requests across the Medicare, Medicaid, Exchange, and Commercial lines of business. They will be required to review the doctor’s request based on defined criteria to determine if the medication can be approved or denied. The RFS production goal is 90%. This goal should be met daily and monthly. This goal roughly averages to 47 cases completed per day. The quality goal is 99.9%. Accountability: Setting clear goals, being transparent about outcomes, and inviting feedback to foster growth. Courage: Pushing past fear and uncertainty to make the best possible decisions. Curiosity: Approaching every interaction as an opportunity to learn. Trust: Demonstrating integrity, honesty, and vulnerability to build strong relationships. Service: Focusing our work through the lens of our mission. Develop clinical criteria for medications, recommend plan design changes, and clinical programs to be initiated Monitor prior authorization requests Provide clinical support to internal departments and address clinical related questions Ensure appropriate quality controls and initiates opportunities for performance improvement in pharmacy/practice Develop and implement programs designed to impact DUR for both Medicaid and Medicare Develop, implement, and maintain policies and procedures for the pharmacy department Participate in the coordination of the Medicare MTM program Assist case management team with members including clinical rounds presentations Requirements: Bachelor’s or Doctorate of Pharmacy degree. Current state Pharmacist license with no restrictions. Preferred: Pharmacist Licenses we required based on business needs: NC, AZ, KS, TX, IN, G, NJ, CA, FL 1+ years of retail, hospital, managed care, or PBM experience. Previous experience with reviewing prior authorizations for a managed care organization/PBM. Preferred experience with outlook, teams, SharePoint, excel