Adjudication Systems, Artificial Intelligence (AI), Biotech and Pharmaceutical, Call Volume, Clinical Practices/Protocols, Clinical Support, Cold Calling Skills, Consulting, Corporate Compliance, Disease, Drug Products, Employee Benefits, Formulary, Health Plan, Insurance, Maintain Compliance, Managed Care, Medicaid, Medicare, Medications, Performance Management, Pharmacy, Short Messaging Service (SMS), Statistics, Utilization Management, Work From Home
Immediate need for a talented Clinical Pharmacist. This is a 05+months contract opportunity with long-term potential and is located in NC(Remote). Please review the job description below and contact me ASAP if you are interested.
Job ID: 26-14274
Pay Range: $50/hr - $58/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
- Review prior authorization requests and make determinations for drug products according to member benefits and coverage criteria
- Report to utilization review statistics to corporate compliance committees
- Review data and summarize daily utilization review numbers
- Responsible for tracking compliance of review cases
- Provide clinical guidance and support to the assigned pharmacy technicians
- Knowledge of drug coding (NDC, GCN, GPI and USC) and NCPDP claims adjudication systems
- Review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design.
- Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices
- Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews Hiring Requirements
- Participating in comprehensive medication review. Cold calling members and reaching out on non adherence. Advocate for
- member on adherence gaps. Time that you will be on the phone is going to be 3.5 to 4.5 hours a day
Key Requirements and Technology Experience:
- Bachelor's degree or advanced degree
- 3+ years of experience in related field.
- Current states pharmacy license.
- Shift/Work Schedule : M-F 8-5 EST
- Able to work on computers and has work from home experience.
- Pharmacist experience
- High volume call
- Medicare and Medicaid experience
- Health Plan
- Managed care experience
- MTM/CMR
- Years of Experience: 3-5
- Education/Certifications Required: Pharmacist license for the state. Pharm D is preferred
- Industry Specific Experience – required, ideal, necessary? Retail, HMO, DSNIP
Our client is a leadingHealth Insurance Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
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