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Clinical Pharmacist
2 months ago
Ongoing: M-F, 8AM-5PM CST
Training: M-F, 8AM-5PM CST with one weekend towards the end.
Some weekends but not every weekend will be required
Responsibilities:
This role will be completely remote - candidates can be sourced from across the US as long as they're able to support the CST schedule.
Candidates must have a quiet and private working environment and have a reliable, high-speed internet connection.
Candidates must have a hard-wired internet connection to connect with their equipment. WiFi will not suffice.
Consults with nursing and medical staff on prescription orders, patient reactions, and errors or complaints. Conducts drug utilization reviews and prepares drug review criteria for medical staff approval. PharmD degree preferred.
They will perform precertification medical necessity review for Part B medications and treatments.
- Performs benefit-driven medical necessity reviews for coverage, case management, and claims resolution, using benefit plan information, applicable federal and state regulations, clinical guidelines, and best practice principles.
The nurses will process and review the cases and send to the pharmacist to review it does not meet medical necessity. The pharmacist will then either approve or deny.
Skills/Requirements:
NON-NEGOTIABLE SKILLS
- Experience in medical management, utilization review and case management in a managed care setting.
- Knowledge of managed care products and strategies.
- Demonstration of strong and effective abilities in teamwork, negotiation, conflict management, decision-making, and problem-solving skills.
- Must have excellent computer skills
- Pharmacy Degree (Pharm. D) or equivalent
- Licensed Pharmacist required
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- 2+ years practicing Pharmacy experience with strong clinical skills
- 2+ years of direct Medicare coverage review/utilization management experience preferred
- Pharmacy Residency or Board Certification preferred (i.e. Board Certified Pharmacotherapy Specialist (BCPS)
- Knowledge of Microsoft Office Suite Word and Excel software and the ability to quickly learn proprietary systems
- bility to adapt to changing environments and processes
- Strong organization and planning skills
- Team oriented with strong verbal and written communication skills
Education:
- Doctor of Pharmacy Degree
