Remote Clinical Pharmacist: Prior Authorization & Utilization Review

Select Source International; Durham (NC); Remote; USD 90,000 - 120,000; Full time

Job summary

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.

Responsibilities

• 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.

Skills

Prior authorization review

Insurance knowledge

Retail pharmacy operations

Team collaboration

Education

Bachelor's degree or advanced degree

Tools

MHK RX claims processing

Prime Therapeutics systems

Job description

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).