Remote Clinical Pharmacist - Prior Authorization & UM

Manpower, Inc.; Durham (NC); Remote; USD 110,000 - 140,000; Full time

Benefits offered by this job

Fully remote work

Weekday daytime schedule

Competitive pay

Leading healthcare organization

Job summary

Manpower, Inc. is seeking a Clinical Pharmacist to support prior authorization reviews and clinical decision-making from a home-based setting.

You will ensure safe, effective medication therapy, provide guidance to technicians, and contribute to quality pharmacy care within PBM and managed care environments. Candidates should hold a pharmacy degree with PharmD preferred, NC license, and at least 3 years of pharmacist experience; remote work experience is a plus.

Qualifications

• Bachelor's Degree in Pharmacy or advanced pharmacy degree required.
• PharmD preferred.
• Current Pharmacist license in the state of North Carolina.
• Minimum of 3 years of pharmacist experience in a related setting.
• Experience working in a remote/work-from-home environment.
• Medicare and Medicaid experience preferred.
• MTM and CMR experience preferred.
• Knowledge of pharmacy benefit management and utilization review processes.
• Ability to meet compliance requirements.

Responsibilities

• Review prior authorization requests and make coverage determinations based on member benefits and established clinical criteria.
• Analyze utilization review data and summarize daily review statistics.
• Track review case compliance and support regulatory requirements.
• Provide clinical guidance and support to pharmacy technicians.
• Evaluate guideline criteria for prior authorization and non-formulary medication requests.
• Support Pharmacy and Therapeutics Committee initiatives and pharmacy benefit design efforts.
• Ensure quality control standards are maintained and identify performance improvement opportunities.
• Research drug information and disease states to support accurate clinical decision-making.
• Utilize knowledge of drug coding systems (NDC, GCN, GPI, and USC) and NCPDP claims adjudication processes.

Skills

Clinical decision making

Multi-system navigation

Prior authorization review

Communication skills

Education

Bachelor's degree in Pharmacy or advanced degree

PharmD preferred

Tools

NDC coding knowledge

NCPDP claims adjudication

GCN/GPI coding

Job description

Manpower, Inc. is seeking a Clinical Pharmacist to support prior authorization reviews and clinical decision-making from a home-based setting.

You will ensure safe, effective medication therapy, provide guidance to technicians, and contribute to quality pharmacy care within PBM and managed care environments. Candidates should hold a pharmacy degree with PharmD preferred, NC license, and at least 3 years of pharmacist experience; remote work experience is a plus.