Lead impactful pharmaceutical reviews and compliance tracking in a remote role. Enhance pharmacy practices through clinical guidance and quality control measures. Utilize advanced drug coding systems for efficient authorization processes.
Clinical Pharmacist
in Healthcare + Life Sciences ContractJob Detail
Job Description
Overview
- Conduct prior authorization reviews for drug products, ensuring compliance with member benefits and coverage criteria.
- Provide clinical guidance and support to pharmacy technicians, enhancing operational efficiency and accuracy.
- Analyze utilization review statistics, preparing reports for corporate compliance committees.
- Evaluate and implement quality controls, driving performance improvements in pharmacy practices.
- Research drug information to maintain updated knowledge for effective authorization reviews.
- Collaborate with Pharmacy and Therapeutics Committee to review guideline criteria for non-formulary drugs.
- Track compliance of review cases, ensuring adherence to established protocols.
- Utilize knowledge of drug coding systems and claims adjudication processes effectively.
Key Responsibilities & Duties
- Review prior authorization requests, applying member benefits and coverage criteria.
- Prepare utilization review statistics for corporate compliance reporting.
- Summarize daily utilization review data for performance tracking.
- Track compliance of review cases, ensuring regulatory adherence.
- Provide clinical guidance to pharmacy technicians, fostering team development.
- Review guideline criteria for prior authorization and non-formulary drugs.
- Evaluate quality controls and implement performance improvement measures.
- Research drug information to support authorization reviews and maintain disease state knowledge.
Job Requirements
- Bachelor's degree in Pharmacy or related field required; advanced degree preferred.
- Minimum of 3 years of relevant experience; 5 years preferred.
- Active state pharmacy license required.
- Proficiency in drug coding systems and claims adjudication processes.
- Strong analytical skills for utilization review and compliance tracking.
- Ability to provide clinical guidance and support to pharmacy technicians.
- Knowledge of Pharmacy and Therapeutics Committee functions and pharmacy benefit design.
- Experience in quality control evaluation and performance improvement implementation.
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