State Licensed Clinical Review Pharmacist

Job Summary

Joining a collaborative clinical team, the part-time remote State Licensed Clinical Review Pharmacist will review prior authorization requests, ensure compliance with regulations, and provide support to members and providers while maintaining thorough documentation and records.

Key responsibilities

• Review and make timely, evidence-based decisions on prior authorizations and appeals using clinical guidelines
• Ensure compliance with federal, state, and internal regulations across applicable lines of business
• Provide clear support to members, prescribers, and pharmacies by responding to clinical inquiries

Required qualifications

• Doctor of Pharmacy (PharmD.) or Bachelor of Science in Pharmacy (B.S. Pharm) from an ACPE-accredited school of pharmacy
• Active, unrestricted pharmacist license in the state of residence
• Minimum of 2 years of pharmacy practice experience
• General understanding of drug information, clinical guidelines, and utilization management strategies
• Availability to work after hours, weekends, and holidays on a rotating or fixed schedule