Job Description

Job Description

Job Title: Clinical Pharmacist I
Location: Remote (U.S.)
Duration: 6 Months (High possibility of extension)
Schedule: 10:00 AM 6:30 PM EST (Overtime possible)
Pay Range: $58.00 - $63.00 Per hr on w2.

Position Overview

We are seeking a highly motivated and clinically driven Clinical Pharmacist to support pharmacy operations within a managed care environment. This role is responsible for reviewing prior authorization requests and coverage determinations for Medicaid, Medicare, and Health Exchange lines of business while ensuring compliance with clinical guidelines and pharmacy benefit requirements.

The ideal candidate will possess strong clinical decision-making abilities, adaptability in a fast-paced environment, and experience working within retail, hospital, mail-order, PBM, or managed care pharmacy settings.

Key Responsibilities

Clinical Review & Prior Authorization

• Review and monitor high-volume prior authorization requests and coverage determinations daily
• Evaluate medication requests based on clinical criteria, formulary requirements, medical necessity, and plan guidelines
• Ensure compliance with Medicaid, Medicare, and Health Exchange program requirements
• Provide clinical recommendations and medication-related guidance to internal departments and stakeholders

Formulary & Clinical Program Support

• Assist in developing and maintaining standard and custom formularies for assigned health plans
• Develop clinical criteria for medications and support plan design enhancements
• Recommend and support implementation of clinical pharmacy programs and utilization management initiatives
• Support Drug Utilization Review (DUR) programs for Medicare and Medicaid populations

Pharmacy Operations & Compliance

• Ensure quality control standards are maintained and identify opportunities for process improvement
• Develop, implement, and maintain pharmacy policies and procedures
• Maintain compliance with regulatory, accreditation, and internal pharmacy standards

Collaboration & Member Support

• Collaborate with case management teams and interdisciplinary healthcare professionals
• Participate in Medicare MTM (Medication Therapy Management) coordination activities
• Assist with clinical discussions, pharmacy rounds, and medication-related consultations

Typical Day in the Role

• Review approximately 140 160 clinical prior authorization requests or coverage determinations daily
• Analyze clinical documentation and medication requests for appropriateness and coverage eligibility
• Collaborate with internal teams regarding pharmacy-related questions and escalations
• Maintain productivity, quality, and turnaround time expectations in a fast-paced environment

Required Qualifications

• Bachelor's Degree or Advanced Degree (PharmD, M.S.) in Pharmacy
• Current unrestricted Pharmacist license in any U.S. state
• 1 3 years of pharmacy experience OR completion of a pharmacy residency program
• Experience in retail, hospital, mail-order, PBM, or managed care pharmacy environments
• Strong clinical decision-making and analytical skills
• Ability to work independently in a remote environment

Preferred Qualifications

• Prior Authorization (PA) review experience
• Managed care or PBM experience
• Experience with Medicare, Medicaid, and Exchange pharmacy programs
• Exposure to formulary management and DUR initiatives
• MTM program experience

Top Skills Required

• Clinical Decision Making
• Adaptability in Fast-Paced Environments
• Ability to Learn New Systems and Processes Quickly
• Prior Authorization Review
• Managed Care Pharmacy Knowledge
• DUR & Formulary Management
• Time Management & Productivity Focus
• Strong Attention to Detail
• Effective Communication Skills

Work Environment

• Fully remote work environment
• High-volume clinical review setting
• Collaborative team-based culture
• Camera-on Teams interviews required
• Flexibility to support occasional weekend rotations preferred

Additional Information

• Interviews conducted via Microsoft Teams
• No vendor testing required
• Strong potential for contract extension based on performance and business needs

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