Pharmacist

Pharmacist Overview

• The Pharmacist will provide expert clinical review and decision-making for pharmaceutical requests under the pharmacy benefit.
• This role involves conducting peer-to-peer discussions with prescribers regarding clinical determinations.
• Participate in quality audits and inter-rater reliability testing to ensure compliance and accuracy.
• Support internal teams by addressing escalations and inquiries from the pharmacy team.
• Apply clinical expertise to promote safe and appropriate pharmaceutical use among members and providers.
• Ensure adherence to all applicable laws, regulations, and organizational policies.
• Engage in comprehensive training programs to enhance clinical and operational knowledge.
• Work remotely, adhering to approved residency state requirements and supervisor guidelines.

Pharmacist Key Responsibilities & Duties

• Review and render decisions on prior authorization requests for pharmaceutical benefits.
• Conduct clinical discussions with prescribers to address adverse determinations.
• Participate in clinical quality audits and ensure inter-rater reliability.
• Provide expert support to pharmacy teams on escalated cases and inquiries.
• Ensure compliance with all relevant laws, regulations, and organizational standards.
• Contribute to the development and application of clinical criteria for pharmaceutical reviews.
• Engage in ongoing training and professional development activities.
• Adhere to scheduled shifts, including weekend and training schedules as outlined.

Pharmacist Job Requirements

• Doctor of Pharmacy (PharmD) degree from an accredited institution.
• Active, unrestricted pharmacist license in the state of residence.
• Minimum of 3 years of experience as a licensed pharmacist.
• Willingness to obtain additional licensure or training as required.
• Experience in clinical review within a managed care setting is preferred.
• Board certification (e.g., BCPS, BCOP) and residency training are advantageous.
• Strong clinical skills and ability to apply clinical criteria effectively.
• Availability to adhere to training and work schedules, including weekend shifts.