Clinical Pharmacist

Pyramid Consulting, Inc; North Carolina; Remote; USD 69,000 - 80,000; Full time

Job summary

Pyramid Consulting, Inc. seeks a Clinical Pharmacist for a 5+ month contract in North Carolina (remote). The role emphasizes prior authorization reviews, clinical guidance, and payer-guideline compliance.

Qualified candidates will have 3+ years in managed care/pharmacy benefits, a valid state Pharmacist license, and the ability to work from home with substantial call handling.

Qualifications

• Bachelor's degree or advanced degree required.
• 3+ years of experience in related field.
• Pharmacist license for the state.

Responsibilities

• Review prior authorization requests and make determinations.
• Report utilization review statistics to committees.
• Provide clinical guidance to pharmacy technicians.
• Ensure quality controls and performance improvement.
• Research drug information for reviews.

Skills

Work From Home

High Call Volume

Medicare/Medicaid Experience

Managed Care

MTM/CMR

Health Plan

Education

Pharmacist license

Pharm D preferred

Tools

NDC coding

GCN

GPI

NCPDP

Job description

Immediate need for a talented Clinical Pharmacist. This is a 05+ months contract opportunity with long-term potential and is located in NC(Remote).

Job ID: 26-21713

Pay Range: $50/hr - $58/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Shift/Work Schedule : M-F 8-5 EST
• 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

Key Requirements and Technology Experience:

• Bachelor's degree or advanced degree
• 3+ years of experience in related field.
• Top 3-4 Required Skills:
• Able to work on computers and has work from home experience.
• High volume call
• Medicare and Medicaid experience
• Health Plan
• Managed care experience
• MTM/CMR
• Years of Experience: 3-5
• Education/Certifications Required: Pharmacist license for the state.
• Pharm D is preferred
• Industry Specific Experience – required, ideal, necessary? Retail, HMO, DSNIP
• Breakdown of Duties/Typical Day:
• Participating in comprehensive medication review.
• Cold calling members and reaching out on non adherence.
• Advocate for member on adherence gaps.
• Time that you will be on the phone is going to be 3.5 to 4.5 hours a day

Our client is a leading Health Insurance Industry, and we are currently interviewing to fill this and other similar contract positions.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.