Clinical Pharmacist

Clinical Pharmacist Overview

• The Clinical Pharmacist will review prior authorization requests and determine drug coverage based on member benefits and criteria.
• Provide clinical guidance and support to pharmacy technicians, ensuring adherence to compliance and quality standards.
• Analyze utilization review statistics and report findings to corporate compliance committees for informed decision-making.
• Evaluate and implement opportunities for performance improvement in pharmacy practices and benefit designs.
• Maintain up-to-date drug knowledge and disease state understanding for effective prior authorization reviews.
• Collaborate with Pharmacy and Therapeutics Committees to review guideline criteria for non-formulary drugs.
• Ensure quality control measures are in place and track compliance of review cases effectively.
• Work remotely, offering flexibility while contributing to impactful pharmacy operations and member care.

Clinical Pharmacist Key Responsibilities & Duties

• Review prior authorization requests for drug products and ensure compliance with member benefits and coverage criteria.
• Analyze daily utilization review data and summarize findings for reporting purposes.
• Track compliance of review cases and implement quality control measures.
• Provide clinical guidance and mentorship to assigned pharmacy technicians.
• Research drug information to maintain expertise in drug coding and claims adjudication systems.
• Collaborate with committees to review guideline criteria for prior authorization and non-formulary drugs.
• Evaluate and implement opportunities for performance improvement in pharmacy practices.
• Ensure compliance with corporate standards and contribute to strategic pharmacy benefit designs.

Clinical Pharmacist Job Requirements

• Doctor of Pharmacy (PharmD) degree is required for this position.
• Minimum of 3 years of experience in a related field, with 5 years preferred.
• Active pharmacy license in the applicable state is mandatory.
• Proficiency in drug coding systems (NDC, GCN, GPI, USC) and claims adjudication systems.
• Strong analytical skills to summarize utilization review data and track compliance.
• Ability to provide clinical guidance and mentorship to pharmacy technicians.
• Knowledge of pharmacy benefit design and prior authorization criteria.
• Experience in remote work environments and ability to collaborate effectively with teams.