Remote Pharmacist

Managed Staffing, Inc.; United States; À distance; USD 110 000 - 140 000; Plein temps

Résumé du poste

Managed Staffing, Inc. is seeking a licensed Pharmacist with experience in Prior Authorization, PBM, and Medicare Part D to support medication access and coverage determinations.

The ideal candidate will review PA requests, evaluate medical records, and collaborate with providers to ensure formulary compliance and appropriate care. You will work remotely, communicating with physicians and pharmacy teams to resolve complex cases and document clinical decisions in accordance with Part D and PBM

Qualifications

• Active and unrestricted RPh/PharmD license.
• 2+ years of Prior Authorization / Clinical Review experience preferred.
• Experience with PBM, Managed Care, Health Plans, or Specialty Pharmacy.
• Strong clinical assessment and medication review skills.
• Excellent provider communication and documentation skills.
• Ability to work independently in a remote environment.

Responsabilités

• Review Prior Authorization (PA) requests for clinical appropriateness and coverage requirements.
• Evaluate patient medical records, medication history, and clinical documentation to support PA determinations.
• Apply PBM, Medicare Part D, formulary, and plan-specific criteria when reviewing medication requests.
• Review medications for dosing, safety, drug interactions, contraindications, and therapeutic appropriateness.
• Conduct clinical reviews for prescription and specialty medications.
• Communicate with physicians, pharmacists, and healthcare providers to obtain additional clinical information when needed.
• Support coverage determinations and medication access decisions.
• Resolve pharmacy benefit, formulary, and insurance-related issues.
• Document clinical reviews, decisions, and provider communications accurately.
• Ensure reviews are completed within applicable Medicare Part D/PBM guidelines and required timelines.
• Collaborate with internal clinical and pharmacy teams to resolve complex medication-related cases.

Connaissances

RPh license

Prior Authorization

PBM knowledge

Medicare Part D

Clinical review

Provider communication

Documentation skills

Remote work capability

Description du poste

We are seeking a licensed Pharmacist with experience in Prior Authorization, PBM, and Medicare Part D. The ideal candidate will have strong clinical review skills and experience evaluating medication requests, applying coverage and formulary requirements, and collaborating with providers to support appropriate medication access.

Responsibilities

• Review Prior Authorization (PA) requests for clinical appropriateness and coverage requirements.
• Evaluate patient medical records, medication history, and clinical documentation to support PA determinations.
• Apply PBM, Medicare Part D, formulary, and plan-specific criteria when reviewing medication requests.
• Review medications for dosing, safety, drug interactions, contraindications, and therapeutic appropriateness.
• Conduct clinical reviews for prescription and specialty medications.
• Communicate with physicians, pharmacists, and healthcare providers to obtain additional clinical information when needed.
• Support coverage determinations and medication access decisions.
• Resolve pharmacy benefit, formulary, and insurance-related issues.
• Document clinical reviews, decisions, and provider communications accurately.
• Ensure reviews are completed within applicable Medicare Part D/PBM guidelines and required timelines.
• Collaborate with internal clinical and pharmacy teams to resolve complex medication-related cases.

Qualifications

• Active and unrestricted RPh/PharmD license.
• 2+ years of Prior Authorization / Clinical Review experience preferred.
• Experience with PBM, Managed Care, Health Plans, or Specialty Pharmacy.
• Strong experience with Medicare Part D.
• Knowledge of formulary requirements, coverage criteria, and pharmacy benefits.
• Strong clinical assessment and medication review skills.
• Excellent provider communication and documentation skills.
• Ability to work independently in a remote environment.