Job Description

Job Description:

Job Title: Clinical Pharmacist 1

Assignment Duration: 6 Months (Possible Extension & Conversion)

Location: Remote
Working Hours: Monday Friday, 9:00 AM 5:30 PM

Position Overview

The Clinical Pharmacist I support Pharmacy Services by reviewing and adjudicating prior authorization requests for medical benefit (buy-and-bill) medications across Medicare, Medicaid, Exchange, and Commercial lines of business. This fully remote role requires strong clinical judgment, in-depth drug knowledge, and experience in managed care or pharmacy benefit management environments.

Key Responsibilities

• Review and adjudicate prior authorization requests for medical benefit (buy-and-bill) drugs using established clinical criteria

• Apply evidence-based guidelines to approve or deny provider medication requests

• Develop and maintain clinical criteria, policies, and procedures related to pharmacy operations

• Support utilization management, drug utilization review (DUR), and quality improvement initiatives

• Collaborate with internal clinical teams, case management, and pharmacy leadership

• Provide clinical consultation and respond to medication-related inquiries from internal stakeholders

• Participate in Medicare Medication Therapy Management (MTM) programs

• Assist case management teams through clinical rounds and complex case reviews

• Meet productivity and quality benchmarks ( 40 cases/day; 90% production, 95 99% quality targets)

• Maintain accurate documentation and compliance with regulatory and organizational standards

Required Qualifications

Education

• Bachelor's degree in Pharmacy or Doctor of Pharmacy (PharmD)

Licensure

• Active, unrestricted Pharmacist license (State-ranked preference below)

Experience

• 1+ years of experience in retail, hospital, managed care, PBM, or mail-order pharmacy

• Prior experience reviewing prior authorizations strongly preferred

Preferred Qualifications

• Managed care or PBM prior authorization review experience

• Medical benefit (buy-and-bill) drug review experience

• Strong clinical decision-making skills

• Experience with Outlook, Microsoft Teams, SharePoint, and Excel

• Ability to work independently in a high-volume, metrics-driven environment

Preferred State Licenses (Ranked)

1. North Carolina

2. California

3. New Jersey

4. Arizona

5. Kansas

6. Texas

7. Indiana

8. Georgia

Why This Role

• Fully remote opportunity

• High-impact role supporting multiple lines of business

• Temp-to-perm conversion potential

• Strong alignment with culture of accountability, curiosity, trust, and service

Job Tags

Similar Jobs