Clinical Pharmacist

Greenkey Resources LLC; Durham (NC); Remote; USD 110,000 - 140,000; Full time

Job summary

Greenkey Resources LLC is seeking a Clinical Pharmacist to review prior authorization requests, ensuring coverage aligns with member benefits and criteria. The role emphasizes maintaining up-to-date drug knowledge and providing clinical guidance to pharmacy technicians, with a focus on compliance and quality standards.

The position supports remote work arrangements, requires analyzing utilization review data, and collaboration with Pharmacy and Therapeutics committees to optimize benefit designs

Qualifications

• PharmD degree required.
• Active state pharmacy license.
• Minimum 3 years in a related field; 5 years preferred.
• Proficiency with drug coding and claims adjudication systems.
• Experience with remote work environments.

Responsibilities

• Review prior authorization requests for drug products and ensure compliance.
• Analyze utilization review data and summarize findings for reporting.
• Track compliance and implement quality control measures.
• Provide clinical guidance and mentorship to pharmacy technicians.
• Collaborate with committees to review guideline criteria for prior authorization.
• Evaluate opportunities for performance improvement in pharmacy practices.
• Ensure compliance with corporate standards and contribute to benefit designs.

Skills

Analytical skills

Remote work experience

Drug coding

Mentorship

Education

PharmD degree

Tools

NDC

GCN

GPI

USC

Job description

Clinical Pharmacist Overview

• The Clinical Pharmacist will review prior authorization requests and determine drug coverage based on member benefits and criteria.
• Provide clinical guidance and support to pharmacy technicians, ensuring adherence to compliance and quality standards.
• Analyze utilization review statistics and report findings to corporate compliance committees for informed decision-making.
• Evaluate and implement opportunities for performance improvement in pharmacy practices and benefit designs.
• Maintain up-to-date drug knowledge and disease state understanding for effective prior authorization reviews.
• Collaborate with Pharmacy and Therapeutics Committees to review guideline criteria for non-formulary drugs.
• Ensure quality control measures are in place and track compliance of review cases effectively.
• Work remotely, offering flexibility while contributing to impactful pharmacy operations and member care.

Clinical Pharmacist Key Responsibilities & Duties

• Review prior authorization requests for drug products and ensure compliance with member benefits and coverage criteria.
• Analyze daily utilization review data and summarize findings for reporting purposes.
• Track compliance of review cases and implement quality control measures.
• Provide clinical guidance and mentorship to assigned pharmacy technicians.
• Research drug information to maintain expertise in drug coding and claims adjudication systems.
• Collaborate with committees to review guideline criteria for prior authorization and non-formulary drugs.
• Evaluate and implement opportunities for performance improvement in pharmacy practices.
• Ensure compliance with corporate standards and contribute to strategic pharmacy benefit designs.

Clinical Pharmacist Job Requirements

• Doctor of Pharmacy (PharmD) degree is required for this position.
• Minimum of 3 years of experience in a related field, with 5 years preferred.
• Active pharmacy license in the applicable state is mandatory.
• Proficiency in drug coding systems (NDC, GCN, GPI, USC) and claims adjudication systems.
• Strong analytical skills to summarize utilization review data and track compliance.
• Ability to provide clinical guidance and mentorship to pharmacy technicians.
• Knowledge of pharmacy benefit design and prior authorization criteria.
• Experience in remote work environments and ability to collaborate effectively with teams.