[Remote] Clinical Staff Pharmacist Remote

Note: The job is a remote job and is open to candidates in USA. Prime Therapeutics is a unique PBM with a purpose beyond profits, seeking to build the future of pharmacy. The Clinical Staff Pharmacist is responsible for processing and documenting Utilization Management requests and collaborating with healthcare providers to address 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