State Licensed Clinical Review Pharmacist

Job Summary

Joining a dynamic clinical team, the full-time remote State Licensed Clinical Review Pharmacist will review prior authorization requests, ensure compliance with regulations, and provide support to members and healthcare providers while enhancing clinical offerings and improving outcomes.

Key responsibilities:

• Review and make 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 empathetic support to members, prescribers, and pharmacies, responding to clinical inquiries professionally

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 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