Remote Pharmacist - Clinical Pharmacist

Pharmacist
- Clinical Pharmacist

Full-Time Contract

Work from home in USA

Remote

Mon-Fri 9-5

$60.00/hour - $63.51/Hour on W2 (USD) (all inclusive)

• Complete Clinical Reviews and provide a determination of Medicare-Medicaid Coverage Determination/Redetermination, Global Exception etc. By reviewing all requests which are not clearly approvable based on specified criteria.
• Continually monitor the quality and efficiency of the Prior Authorization process including coverage criteria, denial language, and communication with prescribers and members.
• Provide recommendations to physicians to improve medication regimens as appropriate.
• Assist in process improvement and work with other members of the coverage determination pharmacy team to ensure quality of reviews.
• Complete all annual NCQA, Aetna required training requirements.
• Assist Member Services and other internal customers in responding to and resolving pharmacy-related inquiries from members (NCQA Requirement).
• Maintain open lines of communication with other functional areas/departments.
• Responsible for staying current with clinical literature and guidelines and relaying those to the program development core teams.

• Proficiency in Microsoft Excel, Word, Outlook, and Share Point
• Superior written and verbal communication skills
• Will considered a recent grad with an active license

• Managed care experience (Medicaid/Medicare)
• 1+ year of previous clinical pharmacy experience required
• 2+ years of experience working as a pharmacist (managed care experience is highly desirable, but not required)
• Knowledge of clinical program components, formulary designs, and prescription benefit trends preferred
• Board certification and managed care residency preferred

Pharm

D. Required. Must have an active license in good standing. License should be active within the state they reside in with no history or restrictions.