Clinical Pharmacist 1 - 210392

Position Title : Clinical Pharmacist 1

Assignment Duration : 3 months

Work Location : Remote

Job Description :

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.

o For a non-formulary drug

o Plan benefits, exclusions

o Quantity limits

o Age restrictions

o Formulary alternatives

o Drug utilization of non-formulary drugs

o Overturned IPS recommended denials

o Audit pharmacy claims greater than $200.00

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

o Updating qty / days or age limit ends

o Support National P&T Committee

Candidate Requirements

Education / Certification

Required : Pharm D.

Preferred : n / a

Licensure

Required : Any US state

Preferred : n / a

Must haves : At least one year of professional RPh experience

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

Disqualifiers : n / a

Performance indicators :

Self-Motivated / Good Time Management Skills

Working Knowledge of Office Suite

Goal Oriented