Clinical Review Pharmacist (REMOTE)
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AI Summary
The pharmacist is responsible for processing and documenting Utilization Management requests, including prior authorizations and formulary exceptions. They provide clinical evaluations and consult with healthcare providers regarding product coverage issues.
About the role
- The Clinical Pharmacist is responsible for the processing and documenting of Utilization Management (UM) requests (e.g. prior authorization, step therapy, formulary exceptions) for delegated products and services. The work is detail-oriented, and candidates will be expected to provide sound clinical judgement and communication.
- Positions are available in Medicare and Commercial lines of business.
What you'll do
- Responsible for the clinical evaluation and determination of client UM requests, which includes consideration of the denial language, as well as the appropriateness of the decision as it pertains to the clinical intent of the individual program criteria.
- Accountable for direct consultation with health care providers concerning non-formulary and clinical product coverage issues.
- Collaborate with team members to promote consistency of clinical decisions across the pharmacist team.
- Other duties as assigned.
Qualifications
- Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy degree.
- Current pharmacist license in good standing at local State Board of Pharmacy.
- Confident in making clinical decisions independently.
- Ability to prioritize tasks and manage multiple projects simultaneously.
- Motivated self-starter who does not require constant direction or feedback to drive results.
- Flexibility to evolve in a dynamic working environment.
- Proficient with learning new computer systems and using multiple monitors.
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