Clinical Pharmacist

Job Title : Clinical Pharmacist

Location : 100% Remote Nationwide

Shift : Mon - Fri 10am – 6 : 30pm EST, OT possible (Flexibility to work a weekend rotation preferred)

Duration : 7 months, possible to extend

Job Duties :

• Review medication prior authorization requests and coverage determinations for Medicaid, Medicare, and Health Exchange lines of business.
• Develop clinical criteria for medications, recommend plan design changes, and initiate clinical programs.
• Review 140 to 160 clinical prior authorizations or coverage determinations daily.
• Monitor prior authorization requests.
• Provide clinical support to internal departments and address clinical-related questions.
• Ensure appropriate quality controls and initiate opportunities for performance improvement in pharmacy / practice.
• Develop and implement programs designed to impact DUR for both Medicaid and Medicare.
• Develop, implement, and maintain policies and procedures for the pharmacy department.
• Participate in the coordination of the Medicare MTM program.
• Assist case management team with members, including clinical rounds presentations.

Requirements :

Candidate Requirements :