Pharmacist - clinical pharmacist

Our Client, a Retail Pharmacy company, is looking for a Pharmacist - Clinical Pharmacist for their Remote location.

Responsibilities:

• Complete Clinical Reviews and provide a determination of Medicare-Medicaid Coverage Determination/Redetermination, Global Exception etc. by reviewing all requests which are not clearly approvable based on specified criteria (algorithms).
• Continually monitor the quality and efficiency of the Prior Authorization process including coverage criteria, denial language, and communication with prescribers and members.
• Provide recommendations to physicians to improve medication regimens as appropriate.
• Complete all annual NCQA, client required training requirements.
• Assists Member Services and other internal customers in responding to and resolving pharmacy-related inquiries from members (NCQA Requirement).
• Maintain open lines of communication with other functional areas/departments.
• Responsible for staying current with clinical literature and guidelines and relaying those to the program development core teams.

Requirements:

• Background/experience (required): Proficiency in Microsoft Excel, Word, Outlook, and SharePoint; Superior written and verbal communication skills; Will consider a recent grad with an active license.
• Background/experience (preferred): Managed care experience (Medicaid/Medicare); 1+ year of previous clinical pharmacy experience required; 2+ years of experience working as a pharmacist (managed care experience is highly desirable, but not required); Knowledge of clinical program components, formulary designs, and prescription benefit trends preferred; Board certification and managed care residency preferred.

Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities