Clinical Pharmacy Reviewer, Pharmacist

This is a fully remote position, open to applicants in United States.

📋 Description

• Assess intricate prior authorization requests, appeals, and medication coverage decisions.

• Ensure clinical appropriateness and adherence to evidence-based standards.

• Serve as a subject matter expert in pharmacy benefit management.

• Analyze complex drug criteria, formulary guidelines, step therapy, and quantity limits for both specialty and non-specialty medications.

• Execute thorough Drug Utilization Review (DUR).

• Make impartial decisions that uphold medical necessity standards.

• Contribute to the delivery of high-quality healthcare and regulatory compliance.

⛳️ Requirements

• Doctor of Pharmacy (PharmD) degree from an accredited institution.

• Active and unencumbered pharmacist license in any U.S. State.

• At least 3 years of experience in Prior Authorization and/or Appeals review within a PBM setting.

• Familiarity with Medicare Part D and Medicaid pharmacy benefits.

• Understanding of commercial insurance pharmacy benefits and formulary management strategies.

• Knowledge of step therapy protocols, quantity limit programs, and specialty medications.

• Extensive knowledge of Drug Utilization Review (DUR).

• Proven ability to interpret and apply complex clinical guidelines.

🏝️ Benefits

• Collaborative remote work culture.

• Opportunities for professional growth.

• Meaningful work that contributes to the healthcare sector.

• Comprehensive benefits package.

• Recognized as a Great Place to Work Certified since 2021.

• Commitment to the development of employees.

• Internet services are not provided by the employer; candidates must arrange and support their own internet connections.

• Reliable internet connection required for remote work.