REMOTE Clinical Pharmacist openings with a major health insurance / managed care company! Starting ASAP!! Apply now with Jake Z. at A-Line!100% REMOTEPay Rate:
$40.00 to $43.00 per hour (determined on experience) Shift Time:
7am to 8pm CST - 8hours per day M-F or 7am-330p CST rotating weekendsJob Summary
The clinical pharmacist is an operation based role that conducts clinical reviews of medical data collected to perform prior authorization for specialty medications. The clinical pharmacist will apply clinical knowledge to plan approved criteria for prospective and concurrent reviews of Medicare D cases. This role will work from CVS Caremark supported systems and make outbound calls to physician or members regarding their pending, approved, or denied prior authorizations. This is a production environment with production and quality goals on set ramp targets.Job Duties:
- 1. Collaborates with multiple groups within CD&A, including answering clinical questions, collecting appropriate clinical/ medical data needed to perform clinical assessments, and reviews as per the health plan/employer agreed criteria within the designated service level agreements. (20%)
2. Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (20%)
3. Reviews cases in progress and provides a Clinical decision regarding Prior Authorizations, Tier Exceptions and Non-Formulary requests (50%)
6. Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required. (10%)
- Knowledge of Access, Power Point, and Visio is preferable.
Must be computer literate - knowledge of Excel and Word.
Licensed Registered Pharmacist in state of residence
Minimum 3-5 years experience although 5-8 years is preferred.
- Tru Care Experience
- Experience in a Managed Care Pharmacy Setting
- Experience with CVS/Health PBM Systems: RxClaim, CAS, MedHOK
- Medicare Part D experience
- Medication Therapy Management MTM/CMR experience (preferred not required)
- Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability
- 401k after 1 year of employment: With employer match and profit sharing
- GREAT Hours! Monday through Friday
- Competitive Pay Rate!
Keywords: RPh, PBM, Pharmacy Benefit Management, RxClaim, CAS, MedHOK, CMR, Clinical Research, Clinical Pharmacy, Dispensing, Compounding, Registered Pharmacist, DUR, Drug Utilization Review, Infusion, MTM, Medication Therapy Management, BPharm, Licensed Pharmacist, PharmD, Prior Authorization, Pharmacy, Pharmaceutical, Mail Order Pharmacy, Prescriptions, Rx, Medication, Clinical Pharmacist, Staff Pharmacist.