More jobs:
Remote - Clinical Pharmacist
Remote / Online - Candidates ideally in
Durham, Durham County, North Carolina, 27703, USA
Listed on 2026-10-16
Durham, Durham County, North Carolina, 27703, USA
Listing for:
Select Source International
Remote/Work from Home
position Listed on 2026-10-16
Job specializations:
-
Healthcare
Pharmacy, Pharmacy Technician
Job Description & How to Apply Below
- Review prior authorization requests and make determinations for drug products according to member benefits and coverage criteria
- Report to utilization review statistics to corporate compliance committees
- Review data and summarize daily utilization review numbers
- Responsible for tracking compliance of review cases
- Provide clinical guidance and support to the assigned pharmacy technicians
- Knowledge of drug coding (NDC, GCN, GPI and USC) and NCPDP claims adjudication systems
- Review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design.
- Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices
- Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
Clinical Pharmacist
Location:
Remote NC Duration: 06 Months
Key Responsibilities
- Review prior authorization requests and make determinations for drug products according to member benefits and coverage criteria
- Report to utilization review statistics to corporate compliance committees
- Review data and summarize daily utilization review numbers
- Responsible for tracking compliance of review cases
- Provide clinical guidance and support to the assigned pharmacy technicians
- Knowledge of drug coding (NDC, GCN, GPI and USC) and NCPDP claims adjudication systems
- Review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design.
- Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices
- Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
- Bachelor's degree or advanced degree
- 3+ years of experience in related field.
- Current states pharmacy license.
License & Credentials: Holds active North Carolina pharmacist license
Professional Background: Retail pharmacy experience with strong insurance knowledge, Prior Authorization review experience, PBM (Pharmacy Benefit Manager) background, and managed care experience
Technical
Skills:
MHK RX claims processing and Prime Therapeutics systems familiarity
Industry
Experience:
Rotation as pharmacy student at health plan/managed care organizations and previous contractor role experience
Strengths: Team player with collaborative approach, strong understanding of retail pharmacy operations and insurance processes, skilled in reviewing and processing prior authorizations
To View & Apply for jobs on this site that accept applications from your location or country, tap the button below to make a Search.
(If this job is in fact in your jurisdiction, then you may be using a Proxy or VPN to access this site, and to progress further, you should change your connectivity to another mobile device or PC).
(If this job is in fact in your jurisdiction, then you may be using a Proxy or VPN to access this site, and to progress further, you should change your connectivity to another mobile device or PC).
Search for further Jobs Here:
×