Per Diem Pharmacist

EmpiRx Health; United States; Hybrid; USD 61,992 - 96,432; Part time

Job summary

A healthcare management firm in the United States seeks a Per Diem Pharmacist to ensure clinical prior authorization and appeal determinations are delivered effectively. The ideal candidate will have a Pharm.D. and a minimum of 3 years of pharmacy experience in clinical settings. The role involves clinical review, oversight, and collaboration with healthcare professionals while utilizing pharmacy management software for documentation.

Qualifications

• Minimum of 3 years of pharmacy experience in clinical, PBM, or managed care settings.
• Prior experience with prior authorization, utilization management, or health plan operations preferred.

Responsibilities

• Act as a clinical expert on prior authorization review and evaluation.
• Monitor and proactively identify clinical interventions for savings.
• Provide guidance and support to members and providers regarding clinical inquiries.

Skills

Strong clinical judgment and analytical thinking skills

Exceptional written and verbal communication

High attention to detail and accuracy in documentation

Excellent organizational and multitasking abilities

Proficient in Microsoft Office Suite and pharmacy systems

Ability to work independently and collaboratively

Education

Pharm.D. degree from an accredited college of pharmacy

Job description

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Position Summary:

In this critical role, the Per Diem Pharmacist ensures clinical prior authorization and appeal determinations are completed in accordance with covered plan design while delivering clinically appropriate pharmacy care and driving sustainable clinical savings for clients. The pharmacist supports EmpiRx Health’s Population Health Management model through collaboration, evidence-based decision-making, and proactive engagement with providers.

Key Responsibilities:

Clinical Review & Determinations

• Act as a clinical expert on prior authorization review and evaluation in accordance with clinical criteria and covered plan design.
• Review, evaluate, and resolve all assigned clinical reviews through comprehensive case review and direct physician engagement aligned with EmpiRx Health’s Population Health Management model.
• Perform peer-to-peer reviews with providers as needed or when requested.
• Convey clinical determinations promptly within established turnaround time requirements to prescribers, members, and healthcare professionals following established approval and denial protocols.

Clinical Oversight & Quality Assurance

• Monitor and proactively identify clinical interventions to ensure clinical savings guarantees are met.
• Review and evaluate current clinical literature to support recommendations and decision-making.
• Participate in continuous quality improvement initiatives to streamline clinical review processes and enhance member care.
• Stay informed on EmpiRx Health formulary updates, clinical programs, and internal policies.
• Provide guidance and support to members, providers, and other healthcare professionals regarding clinical inquiries.
• Collaborate with clinical technicians and prior authorization team members to facilitate clinical review requests, resolve escalations, and answer inquiries.
• Act as a clinical resource for internal staff, supporting staff training and development as needed.
• Proficiently utilize pharmacy management software for case documentation and communications.
• Proficiently utilize Microsoft Office tools to support analysis and reporting.
• Utilize external clinical and drug information resources (e.g., IPD, Policy Reporter, UpToDate, MediSpan) to support reviews, decisions, and awareness of emerging drugs.
• Collaborate cross-functionally with internal clinical teams for claim/data review, clinical interventions, and provider/member/client support as required.

Qualifications & Requirements

Education

• Pharm.D. degree from an accredited college of pharmacy (Required).

Experience

• Minimum of 3 years of pharmacy experience in clinical, PBM, or managed care settings.
• Prior experience with prior authorization, utilization management, or health plan operations preferred.

Licensure/Certifications

• Strong clinical judgment and analytical thinking skills.
• Exceptional written and verbal communication.
• High attention to detail and accuracy in documentation.
• Excellent organizational and multitasking abilities.
• Proficient in Microsoft Office Suite and pharmacy systems.
• Ability to work independently and collaboratively in a fast-paced environment.

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