Clinical Pharmacist

Mindlance; North Carolina; Remote; USD 55,000 - 96,000; Full time

Job summary

Mindlance is seeking a Pharmacy Utilization Review Specialist for a 7–12 month contract, 100% remote. You will review prior authorization requests, determine coverage, and report utilization statistics to compliance committees.

The role includes clinical guidance to pharmacy technicians, maintaining drug knowledge, and ensuring quality controls for performance improvements. Requirements include a Bachelor's degree (or higher) and 3+ years in a related field.

Qualifications

• Bachelor's degree or advanced degree required.
• 3+ years of experience in related field.

Responsibilities

• Review prior authorization requests and determine coverage per member benefits.
• Report 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.

Skills

Utilization review

Clinical guidance

Data reporting

NDC knowledge

Education

Bachelor's degree or advanced degree

Tools

NCPDP claims adjudication systems

GPI coding

USC coding

Job description

Duration: 7 – 12 Months Contract Job Assignment

Location: 100% Remote Job

Job Description:

• 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

• Bachelor's degree or advanced degree
• 3+ years of experience in related field.

EEO:

“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”