Fully Remote-Clinical Pharmacist

Position Summary:
This role serves as a reviewer of prior authorizations.

Primary Duties and Responsibilities

· Review and render decisions on authorizations and appeals for specialty, non-specialty, and physician administered drugs

· Conduct peer-to-peer calls with prescribers to discuss the clinical rationale of adverse determinations

· Participate in clinical quality audits and inter-rater reliability testing

· Provide internal team support for escalations and questions

· Apply clinical expertise to ensure appropriate and safe use of pharmaceuticals by members and providers

· Compliance with all applicable laws and regulations

· Other duties as assigned

Required Experience and Education

· Doctor of Pharmacy Degree

· Active, unrestricted pharmacist license

· 3+ years of experience as a licensed pharmacist

· Willingness to obtain licensure/training with new states, as needed

Preferred Experience and Education

· 3+ years of experience performing clinical review in a managed care setting and experience writing clinical criteria

· Strong clinical skills and experience applying clinical criteria in clinical review setting

· Board Certification (i.e. BCPS, BCOP)

· Residency training

· Experience practicing pharmacy in a clinical setting (i.e. retail, hospital, specialty, etc.)