Per Diem Pharmacist

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

📋 Description

• Serve as a clinical authority on prior authorization assessments and evaluations based on clinical criteria and plan design coverage.

• Analyze, assess, and resolve designated clinical reviews through thorough case evaluations and direct engagement with physicians.

• Conduct peer-to-peer reviews with providers as necessary or upon request.

• Communicate clinical determinations promptly to prescribers, members, and healthcare professionals in accordance with approval and denial protocols.

• Oversee and identify clinical interventions to guarantee that clinical savings commitments are achieved.

• Examine and assess current clinical literature to support recommendations and inform decision-making.

• Engage in ongoing quality improvement initiatives.

• Keep updated on formulary changes, clinical programs, and internal policies.

• Offer guidance and support concerning clinical inquiries.

• Work collaboratively with clinical technicians and prior authorization team members to streamline reviews, address escalations, and respond to inquiries.

• Act as a clinical resource for internal staff and assist in staff training and development.

• Utilize pharmacy management software for case documentation and communication.

• Employ Microsoft Office tools for analysis and reporting purposes.

• Access external clinical and drug information resources, such as IPD, Policy Reporter, UpToDate, and MediSpan.

• Collaborate across functions on claim/data analysis, clinical interventions, and support for providers, members, and clients.

⛳️ Requirements

• Pharm.D. degree from a recognized college of pharmacy (Required).

• At least 3 years of pharmacy experience in clinical, PBM, or managed care environments.

• Prior experience in prior authorization, utilization management, or health plan operations is preferred.

• Active Pharmacist License in good standing (Required).

• Strong clinical judgment and analytical thinking abilities.

• Excellent written and verbal communication skills.

• High level of attention to detail and accuracy in documentation.

• Outstanding organizational and multitasking skills.

• Proficient in Microsoft Office Suite and pharmacy systems.

• Capability to work independently and collaboratively in a fast-paced setting.

• Availability to work up to 25 hours per week between the hours of 8am-8pm EST.

🏝️ Benefits

• Paid Time Off.

• 401(k) program.

• Health Insurance, including Dental & Vision coverage.

• Health Savings Account.

• Employee Assistance Program.