Remote Clinical Pharmacist: Utilization & Coverage

Piper Companies; United States; Remote; USD 114,000 - 128,000; Full time

Benefits offered by this job

Medical

Dental

Vision

401K

Sick leave

Job summary

Piper Companies is seeking a Clinical Pharmacist to join a healthcare and pharmacy benefits organization in a fully remote capacity. This contract opportunity is ideal for a licensed pharmacy professional with experience supporting utilization management, medication coverage determinations, and clinical pharmacy operations within a fast-paced managed care environment.

Responsibilities include evaluating prior authorizations, analyzing utilization data, documenting reviews, and supporting

Qualifications

• Active, unrestricted pharmacist license in the U.S.
• Minimum of 3 years in managed care or related clinical pharmacy
• Experience with utilization management and prior authorization
• Familiarity with NDC, GCN, GPI, USC and NCPDP claims processing
• Strong analytical, decision-making, communication and documentation

Responsibilities

• Conduct clinical evaluations of prior authorization and exception requests using benefit criteria.
• Analyze utilization management activity and prepare reports for compliance monitoring.
• Maintain accurate documentation and tracking of review cases for regulatory adherence.
• Provide day-to-day clinical support to pharmacy technicians in authorization workflows.
• Review literature and formulary guidance to support benefit management and quality initiatives

Skills

Analytical skills

Clinical decision-making

Communication

Documentation

Education

Bachelor's / PharmD

Tools

NDC

GCN

GPI

USC

NCPDP

Job description

Piper Companies is seeking a Clinical Pharmacist to join a healthcare and pharmacy benefits organization in a fully remote capacity. This contract opportunity is ideal for a licensed pharmacy professional with experience supporting utilization management, medication coverage determinations, and clinical pharmacy operations within a fast-paced managed care environment.

Responsibilities include evaluating prior authorizations, analyzing utilization data, documenting reviews, and supporting