State Licensed Clinical Pharmacist

Job Summary

Supporting Medicare Part D members, the full-time remote Clinical Pharmacist I will manage prior authorization and coverage determination reviews, conduct Medication Therapy Management activities, and ensure compliance with CMS regulations while working Monday to Friday from 8 AM to 5 PM Pacific Time.

Key responsibilities:

• Drive accurate and timely Part D coverage decisions by reviewing and rendering determinations and appeals
• Deliver Medication Therapy Management services, conducting comprehensive medication reviews and developing actionable plans for complex patients
• Advance pharmacy quality and compliance initiatives by participating in projects aligned with Medicare Star Ratings and HEDIS measures

Required qualifications:

• Active, unrestricted pharmacist license in at least one U.S. state
• Bachelor's degree in Pharmacy or a related health science field
• Minimum of one year of experience in a health plan, PBM, or managed care pharmacy setting
• Experience with Medicare Part D prior authorization and appeals processes is highly preferred
• Proficiency in conducting Medication Therapy Management and comprehensive medication reviews