Remote Clinical Review Pharmacist
closedSmithRx
πRemote - Worldwide
Job highlights
Summary
Join the clinical services team at SmithRx as a Clinical Review Pharmacist to optimize clinical offerings and outcomes for customers, members, and clients. This is a seasonal contract position with a 6-month contract length, offering opportunities for conversion to full-time based on performance and business need.
Requirements
- Bachelorβs Degree in Pharmacy or PharmD required
- 2-5 years pharmacy experience
- Clear, active pharmacist license
Responsibilities
- Complete prior authorization reviews for all lines of businesses and all edit types
- Responds to escalations from other internal departments
- Apply clinical judgment to evaluate member clinical situation against medication policies and plan benefit design to make coverage determinations for approval or denial, including identification of covered alternatives
- Organize and prioritize multiple requests internally and externally to ensure timely prior authorization case management
- Build and adjust authorizations under protocol within the claim adjudication system
- Triage, assess and respond to pharmacy technicians, member support, account management, benefit/plan operations and document management specialist inquiries regarding claims processing and prior authorization requests
- Maintain open lines of communication with other functional areas within SmithRx
- Provide effective communication of SmithRxβs vision, mission, values and goals
Preferred Qualifications
- 1 year experience with prior authorizations for commercial plans
- Strong clinical skills with the ability to apply sound clinical judgment to a variety of complex situations
- Proficiency in drug literature and clinical trial evaluation, including electronic databases such as Micromedex, Medline, and UptoDate
- Emphasis on problem solving skills, including identifying and accepting a challenging situation and proposing a solution
- Proficiency in MS Word, Excel, and Powerpoint including tables, charts and figures preferred
This job is filled or no longer available
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