Remote - Clinical Pharmacist

Select Source International; Durham (NC); À distance; USD 90 000 - 120 000; Plein temps

Résumé du poste

Select Source International is seeking a Clinical Pharmacist for a remote NC contract role lasting 6 months. You will review prior authorizations, provide clinical guidance to technicians, and ensure compliance with coverage criteria and quality controls.

Ideal candidates have a pharmacy license in the state, 3+ years of related experience, and strong knowledge of drug coding and claims systems (NDC, GCN, GPI, USC; NCPDP).

Qualifications

• Bachelor's degree or advanced degree is required.
• 3+ years of experience in a related field.
• Current state pharmacy license is required.

Responsabilités

• Review prior authorization requests and determine coverage based on member benefits.
• Report utilization review statistics to corporate committees.
• Summarize daily utilization review numbers.
• Track compliance of review cases.
• Provide clinical guidance to assigned pharmacy technicians.
• Knowledge of NDC, GCN, GPI, USC coding and NCPDP claims adjudication.
• Review criteria for prior authorization and non-formulary drugs for Pharmacy & Therapeutics.
• Ensure quality controls and implement performance improvements in pharmacy practices.
• Research drug information to support prior authorization reviews.

Connaissances

Prior authorization review

Insurance knowledge

Retail pharmacy operations

Team collaboration

Formation

Bachelor's degree or advanced degree

Outils

MHK RX claims processing

Prime Therapeutics systems

Description du poste

• 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

Job Title: Clinical Pharmacist

Location: Remote NC

Duration: 06 Months

Key Responsibilities

• 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.
• Current states pharmacy license.

Preferred Candidate Qualifications

License & Credentials: Holds active North Carolina pharmacist licenseProfessional Background: Retail pharmacy experience with strong insurance knowledge, Prior Authorization review experience, PBM (Pharmacy Benefit Manager) background, and managed care experienceTechnical Skills: MHK RX claims processing and Prime Therapeutics systems familiarityIndustry Experience: Rotation as pharmacy student at health plan/managed care organizations and previous contractor role experienceStrengths: Team player with collaborative approach, strong understanding of retail pharmacy operations and insurance processes, skilled in reviewing and processing prior authorizations