Job Description

Position Title: Clinical Pharmacist 1

Location: Remote

Duration: 3 Months

Schedule: 9am 6pm EST, No OT

PR: $60-65.00/HR

Key Responsibilities

• Reviews a completed prior authorization request received from the provider and/or reviews the pharmacy technician's recommended denial, suggested formulary alternatives, comments, and attachments for appropriateness.
• Verifies member's ID number and date of birth.
• Verifies member's eligibility in the appropriate health plan eligibility system.
• Records carrier and group number if applicable.
• Checks for previous prior authorization decisions.
• Verifies coverage in member's prescription benefit when necessary.
• Verifies coverage in member's health plan benefit when necessary.
• Evaluates prescription claim history.
• Reviews chart notes and/or lab values.
• Identifies provider specialty when appropriate.
• Applies Medical Policy Criteria to prior authorization requests.
• Evaluates whether request meets criteria for approval.
• Reviews the request using professional clinical judgment on a case-by-case basis. A pharmacist will review medication requests not addressed by P&T Committee criteria or guidelines, develop and draft criteria for the non-formulary medication requested.
• Researches and contributes drug references and clinical information to facilitate prior authorization review: directly to physicians via fax or phone encounter; or to pharmacy technicians via memo or on a personal level as an educational tool

Communicates with physicians regarding prior authorization:

• For a non-formulary drug
• Plan benefits, exclusions
• Quantity limits
• Age restrictions
• Formulary alternatives
• Retrieves and collects data through available reporting resources (i.e. Discoverer, IT Department)

Education Required: Pharm D.

License Required: Any US state

Licensure in the following states COULD be a plus NC, IN, WA, NH, GA

Must haves: At least one year of professional RPh experience

Nice to haves: Some experience working in managed care, understanding of Medicare/Medicaid law

Performance indicators: Sign 85 100 cases daily

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