Job Description

Job Title: Clinical Pharmacist I
Location: Remote
Duration: 6 Months (High possibility of extension)
Schedule: 10:00 AM 6:30 PM EST (Overtime possible + Weekend rotation flexibility required)

Position Overview

We are seeking a detail-oriented and clinically strong Clinical Pharmacist to support pharmacy operations within a managed care environment. This role is focused on prior authorization (PA) reviews and coverage determinations across Medicaid, Medicare, and Health Exchange lines of business.

The ideal candidate will have strong clinical decision-making skills, the ability to work in a high-volume production environment, and experience evaluating medication appropriateness based on clinical guidelines.

Key Responsibilities

Clinical Review & Prior Authorization

• Review and evaluate 140 160 prior authorization requests or coverage determinations daily
• Assess medication requests based on clinical criteria, medical necessity, and plan guidelines
• Ensure compliance with Medicaid, Medicare, and Exchange program requirements

Formulary & Clinical Program Development

• Assist in developing and maintaining formularies and clinical criteria
• Recommend plan design changes and clinical program enhancements
• Support Drug Utilization Review (DUR) initiatives

Clinical Support & Collaboration

• Provide clinical support to internal teams and respond to medication-related inquiries
• Collaborate with case management teams and participate in clinical discussions/rounds

Quality & Compliance

• Maintain quality control standards and identify opportunities for process improvement
• Develop and maintain pharmacy policies and procedures

Programs & Initiatives

• Support Medicare MTM (Medication Therapy Management) programs
• Contribute to pharmacy program implementation and optimization

Team & Work Environment

• Fast-paced, high-volume clinical review environment
• Strong collaboration across pharmacy, case management, and operations teams
• Focus on accuracy, turnaround time, and clinical excellence

Required Qualifications

• Bachelor's or PharmD in Pharmacy
• Active Pharmacist License (unrestricted, any U.S. state)
• 1 3 years of pharmacy experience (retail, hospital, mail order, or managed care) OR pharmacy residency

Preferred Qualifications

• Experience in prior authorization (PA) or managed care
• Familiarity with Medicaid/Medicare guidelines
• Exposure to formulary management or DUR programs

Top 3 Must-Have Skills

1. Strong clinical decision-making ability
2. Ability to learn quickly and adapt in a fast-paced environment
3. High adaptability and productivity focus

Additional Requirements

• Flexibility to support weekend rotations
• Ability to meet high productivity metrics (140 160 cases/day)
• Strong attention to detail and time management skills

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