Clinical Pharmacist for Medication Reviews

1 week ago


Florida, United States Lifelancer Full time

Job Title: Clinical Pharmacist for Medication Reviews

Location: US, Remote

Contract Type: Full-time

Seniority Level:

The Clinical Pharmacist plays a crucial role in the review of prior authorizations for medications requested under the medical benefit. This dynamic position involves developing clinical criteria and medical policies for the review of provider-administered medications, monitoring monthly reports for quality assurance, and staying current with literature, evidence-based medicine, and trends in medicine.

Duties & Responsibilities:
  • Monitor and review prior authorization requests for medications
  • Calculate appropriate billable units based on dosing, indication, weight, BMI, and other clinical considerations
  • Develop clinical criteria and medical policies for the review of medications
  • Ensure all clinical criteria comply with Centers for Medicare and Medicaid Services (CMS) and New York State Department of Health (NYSDOH)
  • Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
  • Conduct prior authorization reviews within timeframes set forth by CMS and/or NYSDOH
  • Collaborate across departments as needed to complete Utilization Management reviews
  • Review monthly reports and provide feedback on trends, ideas for efficiency, and innovation
  • Work well in a team environment and be a team player
  • Additonal duties as assigned or required

Qualifications:
  • Pharmacy degree from an accredited school of pharmacy
  • Registered Pharmacist with a state license in good standing
  • Work experience conducting prior authorization reviews
  • Clinical knowledge of pharmaceuticals and disease states for prior authorization reviews
  • Written and verbal clinical communication skills that are clear, concise, grammatically correct, and professional
  • Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefits

PREFERRED QUALIFICATIONS:
  • PGY1 Managed Care Residency
  • Knowledge of regulations, including but not limited to National and Local Coverage Determinations
  • Demonstrated critical thinking and problem-solving skills
  • Passion for learning, promoting the profession of pharmacy, and interest in growing skills in a dynamic environment
  • Experience leading working meetings
  • PC Skills with Microsoft Outlook, Word, PowerPoint, and Excel

License or Certification: Licensed pharmacist in good standing

Hiring Range:$105,395 - $145,775. Compensation will be contingent upon work experience, education, licenses, and certifications.

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