Clinical Pharmacist for Medication Reviews
1 week ago
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
- 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
- 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
Hiring Range:$105,395 - $145,775. Compensation will be contingent upon work experience, education, licenses, and certifications.
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