State Licensed Clinical Pharmacist

Job Summary

To support clinical programs, the full-time remote State Licensed Clinical Pharmacist will perform Prior Authorizations, conduct Drug Utilization Reviews, and assist Customer Care with clinical inquiries, while interfacing with healthcare providers regarding beneficiaries' therapeutic interventions.

Key responsibilities

• Support and provide input to clinical programs such as Health Management and Drug Utilization Review to enhance drug therapy efficiency and appropriateness
• Review and make coverage determination decisions for Prior Authorization requests, ensuring compliance with specified criteria
• Monitor and improve the quality and efficiency of the Coverage Determination process, including communication with prescribers

Required qualifications

• Bachelor's degree in Pharmacy or Pharm D, with current, unrestricted licensure as a Registered Pharmacist in the state of residence
• Two years of work experience in a clinical setting or completion of a clinical or managed care pharmacy practice residency
• Knowledge of the PBM industry, formulary management, and managed care principles
• Exceptional clinical skills and sound clinical judgment
• Proficiency in drug literature evaluation and electronic databases