Clinical Pharmacist

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Assess prior authorization requests and make decisions regarding drug products based on member benefits and coverage guidelines.

• Present utilization review statistics to corporate compliance committees.

• Analyze data and compile daily utilization review metrics.

• Monitor compliance of review cases.

• Offer clinical guidance and support to designated pharmacy technicians.

• Evaluate guideline criteria for prior authorization and non-formulary medications in alignment with Pharmacy and Therapeutics Committee operations and pharmacy benefit design.

• Ensure and assess quality controls while implementing performance improvement initiatives within pharmacy practices.

• Investigate drug information to enhance knowledge of drugs and disease states for prior authorization evaluations.

⛳️ Requirements

• Bachelor's degree or a higher-level degree.

• Minimum of 3 years of experience in a relevant field.

• Valid pharmacy license in the current state.

• Familiarity with drug coding (NDC, GCN, GPI, and USC).

• Understanding of NCPDP claims adjudication systems.

• Knowledge of prior authorization and non-formulary drug guideline criteria.

• Proficient clinical judgment and medical policy understanding.

• Expertise in drug information and disease state knowledge.

• Capability to review and process prior authorization requests.

• Skill in evaluating quality controls and executing performance enhancements.

🏝️ Benefits

• Annual Incentive Bonus based on achieving corporate goals and individual performance.

• 401(k) plan with employer matching.

• Paid Time Off (PTO).

• Competitive health benefits.

• Wellness programs.

• Comprehensive Total Rewards package.