Clinical Pharmacist

Motion Recruitment; United States; Remote; USD 110,000 - 150,000; Full time

Job summary

Motion Recruitment is seeking a Clinical Pharmacist for a remote position with a nationally recognized health insurance client. The role centers on prior authorization reviews, clinical guidance, and ensuring compliant pharmacy practices.

You will review authorization requests, report utilization statistics, support technicians, and apply drug coding and NCPDP adjudication knowledge. Residency in listed states is required; EST/CST time zones preferred.

Qualifications

• Bachelor's degree or higher in pharmacy or related field.
• 3+ years of experience in a related field.
• Licensed NC Pharmacist.

Responsibilities

• Review prior authorization requests and determine coverage for drug products.
• Report utilization review statistics to corporate compliance committees.
• Summarize daily utilization review numbers.
• Track compliance of review cases.
• Provide clinical guidance to pharmacy technicians.
• Knowledge of drug coding (NDC, GCN, GPI, USC) and NCPDP claims adjudication systems.
• Review guideline criteria for prior authorization and non-formulary drugs.
• Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices.
• Research drug information to support prior authorization reviews.
• Must pass drug test and criminal background check to contract.

Skills

Managed care

Remote work experience

Education

Bachelor's degree or advanced degree

NC Pharmacy license

Job description

Our client, a nationally recognized and award-winning company in the health insurance vertical, has a contract opening for a Clinical Pharmacist. They have over 4 million customers and 5,000+ employees dedicated to providing innovative solutions that simplify the healthcare system, improve efficiency and outcomes while reducing costs.

Location: ** While the position is Remote, work from home, you must reside in North Carolina or one of the following states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming. (Strong preference for EST/CST time zone)

• Required Skills: Bachelor's degree or advanced degree
• 3+ years of experience in related field.
• NC Pharmacy license
• Desired Skills:managed care
• previous work from home experience

Description/Comment:

• 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
• To be eligible to contract at this client you must be able to pass a drug test and criminal background check