Position Title: Clinical Pharmacist 1
Work Location: Remote - NC and CA
Assignment Duration: 06 months, possible temp to hire
Work Schedule: 8-hour shift (typically 9:00 AM - 5:30 PM in worker's time zone)
Work Arrangement: Remote
Position Summary:
Define and develop standard and custom formularies for assigned plans.
Primary duty is reviewing prior authorization requests for medical benefit (buy-and-bill) drugs across multiple lines of business.
Background & Context:
This is a temporary backfill role supporting pharmacy services with responsibility for prior authorization reviews across Medicare, Medicaid, Exchange, and Commercial plans.
Key Responsibilities:
Develop clinical criteria for medications, recommend plan design changes, and clinical programs to be initiated
Monitor prior authorization requests
Provide clinical support to internal departments and address clinical-related questions
Ensure appropriate quality controls and initiate opportunities for performance improvement in pharmacy practice
Develop and implement programs designed to impact DUR for both Medicaid and Medicare
Develop, implement, and maintain policies and procedures for the pharmacy department
Participate in the coordination of the Medicare MTM program
Assist case management team with members, including clinical rounds presentations
Review physician requests for medical benefit (buy-and-bill) drugs and determine approval or denial based on defined criteria
Education/Certification
Required: Bachelor's or Doctorate of Pharmacy degree.
Preferred:
Licensure
Required: Current state's Pharmacist license with no restrictions.
Preferred: Pharmacist Licenses ranked by priority: NC
CA
NJ
AZ
KS
TX
IN
GA
Years of experience required: 1+ years of retail, hospital, managed care, or PBM experience. Previous experience with reviewing prior authorizations.
Disqualifiers:
Additional qualities to look for: Preferred experience with outlook, teams, SharePoint, excel
Preferred: Pharmacist Licenses ranked by priority: NC
CA
NJ
AZ
KS
TX
IN
GA
Top 3 must-have hard skills stack-ranked by importance
1
Decisive clinical decision making
2
Flexibility/adaptability
3
Quick learner
SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at [email protected] if you require reasonable accommodation.
