Job Title: Pharmacist
Location: Remote
Duration: 8 Months
Shift Timings: 10am 6:30pm EST, OT possible
Pay rate: XX58.00-65XX
This team reviews medication prior authorization requests and coverage determinations for the Medicaid, Medicare and Health Exchange lines of business.
A typical day consists of reviewing 140 to 160 clinical prior authorizations or coverage determinations
Must haves: Years of experience required: 1 to 3 years experience
Additional qualities to look for: Flexibility to work a weekend rotation
Licenses/Certifications: Current state's Pharmacist license with no restrictions.
Responsibilities
Develop clinical criteria for medications, recommend plan design changes, and clinical programs to be initiated
Monitor prior authorization requests
Provide clinical support to internal departments and address clinical related questions
Ensure appropriate quality controls and initiates opportunities for performance improvement in pharmacy/practice
Develop and implement programs designed to impact DUR for both Medicaid and Medicare
Develop, implement, and maintain policies and procedures for the pharmacy department
Participate in the coordination of the Medicare MTM program
Assist case management team with members including clinical rounds presentations
Education/Certification
Required: Bachelors / PharmD
Licensure
Required: Current states pharmacist license
Skills:
| Clinical decision making |
| Ability to learn new skills quickly |
| Adaptability |
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