California Licensed Medical Reviewer
Job Summary
Providing pharmacy and clinical expertise, the full-time California Licensed Medical Reviewer will support Medical Review Services for California healthcare programs, focusing on pharmacy review, claim adjudication, and drug utilization review in a remote work environment.
Key responsibilities
- Perform pharmacy and medication-related clinical reviews
- Support pharmacy claim review and adjudication activities
- Document findings and recommendations accurately and timely
Required qualifications
- Current, non-expired pharmacist license from the State of California in good standing
- Three years of experience as a pharmacy consultant for a government or private-sector healthcare payer, or one year of MMIS experience in a large state
- Strong knowledge of pharmacy practices, medication review, and healthcare reimbursement processes
Complete Job Description
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