Clinical Pharmacist 1

Position Title: Clinical Pharmacist 1

Work Location: Remote - NC and CA

Assignment Duration: 06 months, possible temp to hire

Work Schedule: 8-hour shift (typically 9:00 AM - 5:30 PM in worker's time zone)

Work Arrangement: Remote

Position Summary:

Define and develop standard and custom formularies for assigned plans.

Primary duty is reviewing prior authorization requests for medical benefit (buy-and-bill) drugs across multiple lines of business.

Background & Context:

This is a temporary backfill role supporting pharmacy services with responsibility for prior authorization reviews across Medicare, Medicaid, Exchange, and Commercial plans.

Key Responsibilities:

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  Develop clinical criteria for medications, recommend plan design changes, and clinical programs to be initiated

  
  
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  Monitor prior authorization requests

  
  
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  Provide clinical support to internal departments and address clinical-related questions

  
  
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  Ensure appropriate quality controls and initiate opportunities for performance improvement in pharmacy practice

  
  
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  Develop and implement programs designed to impact DUR for both Medicaid and Medicare

  
  
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  Develop, implement, and maintain policies and procedures for the pharmacy department

  
  
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  Participate in the coordination of the Medicare MTM program

  
  
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  Assist case management team with members, including clinical rounds presentations

  
  
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  Review physician requests for medical benefit (buy-and-bill) drugs and determine approval or denial based on defined criteria

  
  
  
  
  
  
  

  Education/Certification	Required: Bachelor's or Doctorate of Pharmacy degree.	Preferred:
  Licensure	Required: Current state's Pharmacist license with no restrictions.	Preferred: Pharmacist Licenses ranked by priority: NC CA NJ AZ KS TX IN GA
  Years of experience required: 1+ years of retail, hospital, managed care, or PBM experience. Previous experience with reviewing prior authorizations. Disqualifiers: Additional qualities to look for: Preferred experience with outlook, teams, SharePoint, excel Preferred: Pharmacist Licenses ranked by priority: NC CA NJ AZ KS TX IN GA
  Top 3 must-have hard skills stack-ranked by importance	1	Decisive clinical decision making
  2	Flexibility/adaptability
  3	Quick learner