Licensed Clinical Pharmacist

Job Summary

To support a growing healthcare team, the full-time Licensed Clinical Pharmacist will review coverage determinations and appeals for clinical appropriateness, conduct Medication Therapy Management (MTM) activities, and participate in pharmacy quality improvement projects, all while working remotely.

Key responsibilities:

• Drive accurate and timely Part D coverage decisions by reviewing and rendering determinations and appeals based on clinical judgment and CMS requirements
• Deliver Medication Therapy Management services, including comprehensive medication reviews and actionable medication action plans for high-risk members
• Advance pharmacy quality and compliance initiatives by participating in projects aligned with Medicare Star Ratings and contributing to member safety metrics

Required qualifications:

• Minimum of 1 year of experience in a health plan, Pharmacy Benefit Manager (PBM), or managed care pharmacy setting
• Bachelor's degree in Pharmacy or a related health science field
• Active and unrestricted Pharmacist license in the applicable state(s)
• Intermediate knowledge of CMS Medicare Part D coverage determination and appeal processes
• Proficiency in conducting comprehensive medication reviews and familiarity with MTM platforms