Clinical Pharmacist – Quality

This is a fully remote position, open to applicants in Illinois, +6 more states.

📋 Description

• Develop and define standard and customized formularies for the assigned plan.

• Create clinical criteria for various medications.

• Suggest modifications to plan design and clinical programs.

• Oversee prior authorization requests.

• Offer clinical support to internal teams and respond to clinical-related inquiries.

• Ensure the implementation of quality controls and identify opportunities for performance enhancement in pharmacy/practice.

• Design and execute programs aimed at influencing Drug Utilization Review (DUR) for Medicaid and Medicare.

• Formulate, execute, and sustain policies and procedures for the pharmacy department.

• Take part in the coordination of the Medicare Medication Therapy Management (MTM) program.

• Support the case management team with members, including presentations during clinical rounds.

• Communicate with providers about quality measures.

• Ensure clinical criteria are in alignment with state regulations.

• Utilize evidence-based research to guide coverage policies and formulary choices.

⛳️ Requirements

• Bachelor’s degree or an advanced degree (Pharm.D., M.S.) in pharmacy.

• Minimum of 2 years of experience in managed care, clinical, hospital, or retail pharmacy, or 1 year of pharmacy residency program experience.

• Valid state Pharmacist license without any restrictions.

• Proficient data analysis skills.

• Strong skills in Microsoft Excel.

• Capability to critically assess clinical trials, treatment guidelines, and pharmaceutical literature.

• Preferred background in clinical pharmacy, managed care, and/or hospital settings.

• Illinois Pharmacist license preferred but not mandatory.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off along with holidays.

• Flexible working arrangements including remote, hybrid, field, or office schedules.

• Additional incentives may be included in the total compensation package.

• Equal opportunity employer dedicated to fostering diversity.