Clinical Pharmacist

Our client, a nationally recognized and award-winning company in the health insurance vertical, has a contract opening for a Clinical Pharmacist. They have over 4 million customers and 5,000+ employees dedicated to providing innovative solutions that simplify the healthcare system, improve efficiency and outcomes while reducing costs.

Location:
** While the position is Remote, work from home, you must reside in North Carolina or one of the following states:
Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming. (Strong preference for EST/CST time zone)

• Required Skills: Bachelor's degree or advanced degree
• 3+ years of experience in related field.
• NC Pharmacy license
• Desired
  
  Skills:
  
  managed care
• previous work from home experience

• 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
• To be eligible to contract at this client you must be able to pass a drug test and criminal background check