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