Clinical Pharmacist

Make an impact in healthcare from the comfort of your home. We're seeking a detail-oriented Clinical Pharmacist who is passionate about improving patient outcomes, ensuring appropriate medication utilization, and supporting quality pharmacy care through prior authorization reviews and clinical decision-making.

As a Clinical Pharmacist, you will play a critical role in ensuring members receive safe, effective, and clinically appropriate medication therapy. Your expertise will help support coverage decisions, maintain compliance standards, and contribute to high-quality pharmacy benefit management.

• Review prior authorization requests and make coverage determinations based on member benefits and established clinical criteria
• Analyze utilization review data and summarize daily review statistics
• Track review case compliance and support regulatory requirements
• Provide clinical guidance and support to pharmacy technicians
• Evaluate guideline criteria for prior authorization and non-formulary medication requests
• Support Pharmacy and Therapeutics Committee initiatives and pharmacy benefit design efforts
• Ensure quality control standards are maintained and identify performance improvement opportunities
• Research drug information and disease states to support accurate clinical decision-making
• Utilize knowledge of drug coding systems (NDC, GCN, GPI, and USC) and NCPDP claims adjudication processes

• A current, up-to-date resume
• Bachelor's Degree in Pharmacy or advanced pharmacy degree required
• PharmD preferred
• Current Pharmacist license in the state of North Carolina
• Minimum of 3 years of pharmacist experience in a related setting
• Experience working in a remote/work-from-home environment
• Strong computer proficiency and ability to navigate multiple systems efficiently
• Ability to manage a high-volume workload and prioritize effectively
• Experience in retail pharmacy, health plan, HMO, DSNP, or managed care environments preferred
• Medicare and Medicaid experience preferred
• Medication Therapy Management (MTM) and Comprehensive Medication Review (CMR) experience preferred
• Knowledge of pharmacy benefit management and utilization review processes
• Ability to meet compliance requirements
• Must be eligible and provide proof of eligibility to work in the US

• Competitive pay
• Fully remote work opportunity
• Consistent Monday-Friday daytime schedule
• Opportunity to work with a leading healthcare organization
• Gain experience in prior authorization, utilization management, and managed care pharmacy
• Collaborative team environment with opportunities to expand clinical expertise

Upon completion of waiting period associates are eligible for: