Remote Clinical Review Pharmacist

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

• Bachelor’s 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 SmithRx’s 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