The Clinical Pharmacist reviews prior authorization and appeal requests to determine medication coverage based on clinical guidelines, pharmacy policies, and health plan benefits. This role works closely with providers, pharmacy technicians, and internal teams to make coverage determinations, recommend formulary alternatives, and ensure regulatory compliance. Success in this role requires strong clinical judgment, attention to detail, and the ability to thrive in a fast-paced, production-driven environment.
Responsibilities:
Review prior authorization and appeal requests
Analyze clinical documentation and make coverage determinations
Recommend formulary alternatives when appropriate
Communicate with providers and healthcare teams
Document case decisions accurately
Ensure compliance with Medicare Part D, Medicaid, and commercial plan guidelines
Manage high case volumes while meeting quality and productivity metrics
Support quality assurance and process improvement initiatives
| Location | (Remote) |
| Job Type | Full-time |
| Industry | Healthcare Services |
| Salary | $59 Per Hour |
| Year Founded | 2001 |
| Headquarters | Atlanta, Georgia, US |
| Website | http://www.insightglobal.net |
Bachelor of Pharmacy or PharmD.
Active State Pharmacist License.
Company Context
ASP is a medical supply company selling products such as syringes, gowns, wound care products, and other healthcare supplies to hospitals and large physician groups.
The company is in growth mode and is targeting roughly 3x revenue growth.
They have been overhauling supply chain operations and have already transformed 4 of their 5 supply chain organizations.
The previous person in the role was promoted to Director, which suggests there is visibility and growth potential.
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