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 tot his job