Remote Clinical Pharmacist – Utilization & Coverage Expert

Zachary Piper Solutions; United States; Remote; USD 69,000 - 83,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k)

Paid holidays

Job summary

Piper Companies is seeking a Clinical Pharmacist for a remote contract opportunity based in North Carolina. The role supports utilization management and formulary decisions to ensure appropriate benefit determinations for members while maintaining regulatory compliance.

You will evaluate prior authorization requests, monitor pharmacy review metrics, assist pharmacy technicians, and conduct research on therapies to support coverage determinations.

Qualifications

• Active North Carolina Pharmacist license and current residence within North Carolina.
• Minimum of 3 years of pharmacist experience with a background in retail pharmacy and Medicare Part D programs.
• Previous telephonic experience working for a Health Insurance Company, Managed Care Organization, or Pharmacy Benefit Management environment.
• Strong knowledge of pharmacy claims adjudication, NCPDP systems, and drug coding classifications including NDC, GCN, GPI, and related standards.
• Bachelor's degree in Pharmacy, PharmD, or advanced healthcare-related degree with demonstrated stability and long-term success in contract-based roles.

Responsibilities

• Evaluate prior authorization and coverage review requests by applying clinical guidelines, plan benefits, and formulary requirements to determine medication eligibility.
• Monitor utilization management activities, analyze pharmacy review metrics, and prepare reports supporting compliance and operational objectives.
• Serve as a clinical resource for pharmacy technicians by providing guidance on pharmacy benefit policies, drug therapies, and review processes.
• Conduct research on medications, treatment protocols, and disease state management to support coverage decisions and formulary initiatives.
• Identify opportunities for quality improvement within pharmacy operations and assist with implementing process enhancements to improve accuracy and efficiency.

Skills

Pharmacist license (NC)

Retail pharmacy experience

Medicare Part D knowledge

Telephonic experience in HIC/PBM

Pharmacy claims adjudication

NCPDP systems

Drug coding (NDC/GCN/GPI)

Regulatory compliance knowledge

Education

Pharmacy degree (PharmD)

Job description

Piper Companies is seeking a Clinical Pharmacist for a remote contract opportunity based in North Carolina. The role supports utilization management and formulary decisions to ensure appropriate benefit determinations for members while maintaining regulatory compliance.

You will evaluate prior authorization requests, monitor pharmacy review metrics, assist pharmacy technicians, and conduct research on therapies to support coverage determinations.