Pharmacist

HIRING a remote Pharmacist!

Job Description:

The Clinical Specialist manages accessibility, quality, and cost-effectiveness of drug and medical therapy for members and providers. This position focuses on initiating, supporting, and continuing cost-effective, rational drug, and disease therapy, utilizing distinct but inter-related management and cross-departmental functions.

Responsibilities:

• Responsible for providing clinical support services to client plan(s) contracting for clinical services
• Support services will include, but not limited to, clinical review, analysis, recommendation, decision and documentation of prior authorization requests, medical exception requests, and appeal requests as required by client contracts and Utilization Management delegation agreements
• Review medication request guidelines for clinical appropriateness and operational efficiency
• Assist in the revision and creation of new or existing medication request guidelines as indicated
• Provide drug information support
• Research and provide clinical literature documentation to support prior authorization decisions as indicated
• May include preparation of Pharmacy and Therapeutics meeting agenda and associated meeting materials including clinical and financial reviews of individual drugs, drug classes, and current therapy for specific disease states and drug formulary review
• Coordinate and assist in the preparation of utilization and compliance reporting for client plans
• Ensure timely preparation and review of plan data and client presentations, when required
• Coordinate and assist with projects associated with prior authorization program development, implementation and internal and external communications
• Provide feedback to Prior Authorization Coordinators (PACs) regarding the processing of PA cases referred for clinical review
• Provide in-service education to PACs regarding topics such as PA guidelines, diagnoses commonly seen as part of the PA review process

Skills

• Pharmacy
• Prior authorization,
• Medicare
• Retail pharmacy
• Medicaid
• Insurance verification
• Pharmacy benefits management