Clinical Pharmacist — PBM Coverage & Appeals

Valid8 Financial, Inc.; Las Vegas (NV); On-site; USD 110,000 - 150,000; Full time

Job summary

SlateRx is seeking a Clinical Pharmacist to review coverage determinations and appeals in alignment with company protocols. You will collaborate with a team to support efficient, accurate, timely, and privacy-conscious decision making.

Responsibilities include interpreting guidelines, obtaining information, communicating decisions to prescribers and members, handling inquiries, and advising on formulary alternatives as needed. A US Pharmacist license is required, with a Pharm.D.

Qualifications

• Pharmacist license in at least one US state.
• Pharmacy degree (B.Pharm or Pharm.D) required.
• Experience with prior authorization and PBM processes.
• Knowledge of state and federal pharmacy regulations.

Responsibilities

• Interpret guidelines and review coverage determinations and appeals.
• Obtain additional information as needed to make decisions.
• Communicate decisions to prescribers, members and health professionals.
• Handle calls and escalations regarding determinations.
• Advise on formulary alternatives when appropriate.
• Utilize clinical resources to support utilization reviews.

Skills

Clinical guidelines

Prior Authorization

PBM industry knowledge

Drug therapy discussion

Regulatory compliance

Team collaboration

Computer proficiency

Education

Bachelor of Pharmacy or Pharm.D.

Tools

PA system

Job description

SlateRx is seeking a Clinical Pharmacist to review coverage determinations and appeals in alignment with company protocols. You will collaborate with a team to support efficient, accurate, timely, and privacy-conscious decision making.

Responsibilities include interpreting guidelines, obtaining information, communicating decisions to prescribers and members, handling inquiries, and advising on formulary alternatives as needed. A US Pharmacist license is required, with a Pharm.D.