Clinical Pharmacist

Clinical Pharmacist Overview

• The Clinical Pharmacist role involves reviewing prior authorization requests for drug products based on member benefits and coverage criteria.
• Collaborate remotely in a contract position, offering flexibility and potential for extension or conversion.
• Utilize your expertise in drug coding systems and claims adjudication processes to ensure compliance and quality.
• Provide clinical guidance to pharmacy technicians and contribute to performance improvement initiatives.
• Engage in research to maintain updated drug knowledge and disease state understanding.
• Support Pharmacy and Therapeutics Committee functions and pharmacy benefit design through guideline reviews.
• Track compliance of review cases and report utilization review statistics to corporate compliance committees.
• This role is ideal for mid-level professionals seeking impactful contributions in clinical pharmacy.

Clinical Pharmacist Key Responsibilities & Duties

• Review prior authorization requests and determine drug product eligibility based on coverage criteria.
• Report utilization review statistics to corporate compliance committees for regulatory adherence.
• Summarize daily utilization review data and track compliance of review cases.
• Provide clinical guidance and support to pharmacy technicians in their daily operations.
• Evaluate quality controls and implement performance improvement opportunities in pharmacy practices.
• Research drug information to maintain updated knowledge for prior authorization reviews.
• Review guideline criteria for non-formulary drugs and support pharmacy benefit design.
• Ensure compliance with drug coding systems and claims adjudication processes.

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.
• Current state pharmacy license is mandatory for eligibility.
• Proficiency in drug coding systems such as NDC, GCN, GPI, and USC.
• Experience with NCPDP claims adjudication systems and prior authorization processes.
• Strong analytical skills for summarizing utilization review data and compliance tracking.
• Ability to provide clinical guidance and support to pharmacy technicians effectively.
• Knowledge of pharmacy benefit design and guideline criteria for non-formulary drugs.