Clinical Pharmacist (Remote) (Medicare or Managed Care)
Overview
We are seeking experienced Clinical Pharmacists to support a large new healthcare initiative within a leading managed care environment.
This is an excellent opportunity for pharmacists with Medicare, Medicaid, or managed care experience who are passionate about delivering high-quality patient care while working in a fully remote environment.
- Key Responsibilities
- Review prior authorization requests and determine approval/denial based on member benefit plans and clinical coverage criteria.
- Evaluate formulary and non-formulary medication requests in alignment with Pharmacy & Therapeutics (P&T) committee guidelines.
- Conduct comprehensive medication reviews (CMR) to support medication optimization and adherence.
- Collaborate with pharmacy technicians, case managers, and healthcare teams to improve patient care outcomes.
- Contact members to address medication non-adherence and therapy gaps.
- Review and summarize daily utilization review metrics and statistics.
- Ensure compliance and quality control across pharmacy utilization review cases.
- Provide clinical guidance and oversight to pharmacy support staff.
- Research drug information to support evidence-based clinical decision making.
- Work within NCPDP claims adjudication systems and utilize drug coding structures including NDC, GCN, GPI.
- Required Qualifications
- Bachelor’s Degree in Pharmacy (PharmD preferred).
- Active Pharmacist License
- Minimum 3+ years of pharmacy experience.
- Prior experience in Managed Care, Health Plans, HMO, Retail Pharmacy, or DSP environments.
- Familiarity with Medicare and Medicaid programs.
- Strong experience with prior authorization reviews and medication therapy management.
- Comfortable working remotely with digital pharmacy systems and clinical review platforms.
- Preferred Experience
- Medicare STAR Ratings and Quality Metrics
- Medication adherence programs
- Pharmacy utilization management
- Managed care clinical pharmacy operations
Apply Now
Apply Now