Job Description

Title: Clinical Pharmacist

Location: Remote

Duration: 3 months (Potential Extension)

Schedule: 9am 6pm EST No OT

XXXX: XXXXXXXXXXX0 to XXXXXXXXXXX7 an hour

Typical role in a day:

• Reviews a completed prior authorization request received from the provider and/or reviews the pharmacy technician's recommended denial, suggested formulary alternatives, comments and attachments for appropriateness.

• Verifies member's ID number and date of birth.

• Verifies member's eligibility in the appropriate health plan eligibility system.

• Records carrier and group number if applicable.

• Checks for previous prior authorization decisions.

• Verifies coverage in member's prescription benefit when necessary.

• Verifies coverage in member's health plan benefit when necessary.

• Evaluates prescription claim history.

• Reviews chart notes and/or lab values.

• Identifies provider specialty when appropriate.

• Applies Medical Policy Criteria to prior authorization requests.

• Evaluates whether request meets criteria for approval.

• Reviews the request using professional clinical judgment on a case by case basis. A pharmacist will review medication requests not addressed by P&T Committee criteria or guidelines, develop and draft criteria for the non-formulary medication requested.

• Researches and contributes drug references and clinical information to facilitate prior authorization review: directly to physicians via fax or phone encounter; or to pharmacy technicians via memo or on a personal level as an educational tool

• Communicates with physicians regarding prior authorization:

• For a non-formulary drug

• Plan benefits, exclusions

• Quantity limits

• Age restrictions

• Formulary alternatives

• Retrieves and collects data through available reporting resources (i.e. Discoverer, IT Department)

• Compiles data for reporting purposes:

• Drug utilization of non-formulary drugs

• Overturned IPS recommended denials

• Audit pharmacy claims greater than XXXXXXXXXXX

• Suggest addition or deletion of drugs to/from the formulary

• Updating qty/days or age limit ends

• Support National P&T Committee

• Other tasks which may arise during the performance of any of the above mentioned duties

Education/Certification:

• Pharm D.

Licensure

• Registered pharmacist (RPh).

Must haves: At least one year of professional RPh experience

Nice to haves: Some experience working in managed care, understanding of Medicare/Medicaid law

Performance indicators: Sign 85 100 cases daily

Top 3 must-have hard skills

Self-Motivated/Good Time Management Skills

Working Knowledge of Office Suite

Goal Oriented

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