Remote Pharmacist - Clinical Pharmacy Reviewer

Dane Street, LLC; United States; Remote; USD 110,000 - 140,000; Full time

Benefits offered by this job

Remote culture

Professional growth

Comprehensive benefits

Great Place to Work Certified

Job summary

Dane Street seeks a Clinical Pharmacy Reviewer (Pharmacist) to evaluate complex prior authorization requests, appeals, and coverage determinations in order to ensure clinical appropriateness and evidence-based practice.

The role requires interpreting drug criteria, formulary guidelines, step therapy, and quantity limits for specialty and non-specialty medications, with emphasis on Drug Utilization Review and medical necessity.

Qualifications

• Minimum 3 years PA/Appeals review in PBM environment.
• Doctor of Pharmacy degree and active pharmacist license in the U.S.

Responsibilities

• Evaluate complex prior authorization requests and appeals for clinical appropriateness.
• Interpret formulary guidelines, step therapy, and quantity limits for medications.
• Perform Drug Utilization Review to uphold medical necessity and regulatory standards.

Skills

Prior Authorization review

Appeals review

DUR knowledge

Formulary management

Medicare Part D knowledge

Regulatory compliance

Education

PharmD degree

Job description

Dane Street seeks a Clinical Pharmacy Reviewer (Pharmacist) to evaluate complex prior authorization requests, appeals, and coverage determinations in order to ensure clinical appropriateness and evidence-based practice.

The role requires interpreting drug criteria, formulary guidelines, step therapy, and quantity limits for specialty and non-specialty medications, with emphasis on Drug Utilization Review and medical necessity.