State Licensed Clinical Review Pharmacist

Job Summary

Joining a collaborative clinical team, the full-time Clinical Review Pharmacist will review prior authorization requests, ensure compliance with regulations, and provide support to members and providers in a remote setting.

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
• Active, unrestricted pharmacist license in 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