Clinical Pharmacist

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

📋 Description

• Deliver timely drug therapy solutions for health plan members by assessing and processing prior authorization requests using clinical expertise and medical policies.

• Evaluate prior authorization requests and make determinations for pharmaceutical products based on member benefits and coverage criteria.

• Present utilization review data to corporate compliance committees.

• Analyze data and compile daily utilization review statistics.

• Monitor compliance regarding review cases.

• Offer clinical guidance and assistance to assigned pharmacy technicians.

• Assess guideline criteria for prior authorization and non-formulary drugs in support of the Pharmacy and Therapeutics Committee's functions and pharmacy benefit design.

• Ensure quality control measures are upheld and implement opportunities for enhancing performance within pharmacy practices.

• Investigate drug information to maintain knowledge of pharmaceuticals and disease states applicable to prior authorization assessments.

⛳️ Requirements

• Bachelor's degree or an advanced degree.

• Over 3 years of experience in a related field.

• Valid state pharmacy license.

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

• Understanding of NCPDP claims adjudication systems.

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

• Strong clinical judgment and understanding of medical policies.

• Comprehensive knowledge of drugs and disease states.

• Awareness of pharmacy practices, quality control measures, and performance enhancement strategies.

• Insight into pharmacy regulations, medication management, medication safety, and associated pharmacy operations.

🏝️ Benefits

• Annual Incentive Bonus tied to corporate goal attainment and individual performance.

• 401(k) plan with employer matching contributions.

• Paid Time Off (PTO).

• Competitive health benefit options.

• Wellness initiatives.

• Comprehensive Total Rewards package.