Make an impact in healthcare from the comfort of your home. We're seeking a detail-oriented Clinical Pharmacist who is passionate about improving patient outcomes, ensuring appropriate medication utilization, and supporting quality pharmacy care through prior authorization reviews and clinical decision-making.
Why This Role Matters
As a Clinical Pharmacist, you will play a critical role in ensuring members receive safe, effective, and clinically appropriate medication therapy. Your expertise will help support coverage decisions, maintain compliance standards, and contribute to high-quality pharmacy benefit management.
What You'll Do
- Review prior authorization requests and make coverage determinations based on member benefits and established clinical criteria
- Analyze utilization review data and summarize daily review statistics
- Track review case compliance and support regulatory requirements
- Provide clinical guidance and support to pharmacy technicians
- Evaluate guideline criteria for prior authorization and non-formulary medication requests
- Support Pharmacy and Therapeutics Committee initiatives and pharmacy benefit design efforts
- Ensure quality control standards are maintained and identify performance improvement opportunities
- Research drug information and disease states to support accurate clinical decision-making
- Utilize knowledge of drug coding systems (NDC, GCN, GPI, and USC) and NCPDP claims adjudication processes
What We're Looking For
- A current, up-to-date resume
- Bachelor's Degree in Pharmacy or advanced pharmacy degree required
- PharmD preferred
- Current Pharmacist license in the state of North Carolina
- Minimum of 3 years of pharmacist experience in a related setting
- Experience working in a remote/work-from-home environment
- Strong computer proficiency and ability to navigate multiple systems efficiently
- Ability to manage a high-volume workload and prioritize effectively
- Experience in retail pharmacy, health plan, HMO, DSNP, or managed care environments preferred
- Medicare and Medicaid experience preferred
- Medication Therapy Management (MTM) and Comprehensive Medication Review (CMR) experience preferred
- Knowledge of pharmacy benefit management and utilization review processes
- Ability to meet compliance requirements
- Must be eligible and provide proof of eligibility to work in the US
What's In It For You
- Competitive pay
- Fully remote work opportunity
- Consistent Monday-Friday daytime schedule
- Opportunity to work with a leading healthcare organization
- Gain experience in prior authorization, utilization management, and managed care pharmacy
- Collaborative team environment with opportunities to expand clinical expertise
Benefits for Manpower Associates (Upon Eligibility)
Upon completion of waiting period associates are eligible for: