Clinical Review Pharmacist
New
S
SmithRxPharmacy benefit management
Location: US - RemoteContractJunior
Salary63 - 65 USD per year
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Job Details
- Experience
- Minimum of 2 years of pharmacy practice experience
- Required Skills
- Google WorkspaceHIPAA
Requirements
- Hold a Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy (B.S. Pharm) from an ACPE-accredited school of pharmacy.
- Maintain an active, unrestricted pharmacist license in your state of residence.
- Have a minimum of 2 years of pharmacy practice experience.
- Bring a general understanding of drug information, clinical guidelines, formulary design, and utilization management strategies.
- Be able to manage multiple priorities in a high-volume, metric-driven environment.
- Have strong communication, writing, and organizational skills.
- Be available to work after hours, weekends, and holidays on a rotating or fixed schedule.
- Prior authorization or utilization management experience is preferred.
- Managed care or pharmacy benefit management experience is preferred.
- Experience conducting prior authorization reviews, clinical appeals, formulary exceptions, step therapy evaluations, and quantity limit reviews is preferred.
- Experience with Google Workspace, including Gmail, Docs, Sheets, and Drive, is preferred.
Responsibilities
- Review prior authorizations and appeals and make timely, evidence-based decisions using clinical guidelines and benefit criteria.
- Ensure compliance with federal, state, and internal regulations across applicable lines of business.
- Document clinical decisions and maintain records according to URAC and NCQA utilization review standards.
- Respond to clinical inquiries from members, prescribers, and pharmacies.
- Stay current with prescribing guidelines, internal policies, and regulatory changes.
- Follow internal procedures, job aids, and HIPAA guidelines to protect patient privacy and data security.
- Identify and report potential fraud, waste, and abuse.
- Support training and development of team members as needed.
- Assist leadership with special projects, process improvements, and operational initiatives.
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