[Remote] Clinical Pharmacist Reviwer- REMOTE

Note: The job is a remote job and is open to candidates in USA. Prime Therapeutics is a unique pharmacy benefit manager focused on connecting care for those they serve. They are seeking a Clinical Pharmacist Reviewer responsible for processing and documenting Utilization Management requests and collaborating with healthcare providers on clinical product coverage issues.

Responsibilities

• Process the clinical evaluation for coverage determination requests for prior authorization (PA) or other utilization management (UM) programs, including quantity limits, step therapy, formulary exception and tier exception; this includes consideration of the denial language and appropriateness of the decision as it pertains to the clinical content of the case and the intent of the individual client’s pre-approved criteria
• Consult directly with healthcare providers to address non-formulary and clinical product coverage issues
• Collaborate with team members to ensure consistent decision-making across the pharmacist team
• Respond to medication-related inquiries via phone, providing accurate information to patients, providers, and clinics regarding medications, formulary options, and coverage questions
• Other duties as assigned

Skills

• Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy Degree
• 1 years of work experience in clinical, retail, hospital, or managed care
• Current pharmacist license in good standing with the State Board of Pharmacy
• Must be eligible to work in the United States without the need for work visa or residency sponsorship
• Strong verbal and written communication skills
• Ability to work efficiently with computers and digital tools
• Managed care experience

Company Overview