Remote - Clinical Pharmacist Job at Select Source International in Durham

* Review prior authorization requests and make determinations for drug products according to member benefits and coverage criteria
* Report to utilization review statistics to corporate compliance committees
* Review data and summarize daily utilization review numbers
* Responsible for tracking compliance of review cases
* Provide clinical guidance and support to the assigned pharmacy technicians
* Knowledge of drug coding (NDC, GCN, GPI and USC) and NCPDP claims adjudication systems
* Review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design.
* Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices
* Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
JOB TITLE: CLINICAL PHARMACIST
LOCATION: REMOTE NC
DURATION: 06 MONTHS
KEY RESPONSIBILITIES
* Review prior authorization requests and make determinations for drug products according to member benefits and coverage criteria
* Report to utilization review statistics to corporate compliance committees
* Review data and summarize daily utilization review numbers
* Responsible for tracking compliance of review cases
* Provide clinical guidance and support to the assigned pharmacy technicians
* Knowledge of drug coding (NDC, GCN, GPI and USC) and NCPDP claims adjudication systems
* Review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design.
* Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices
* Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
HIRING REQUIREMENTS
* Bachelor's degree or advanced degree
* 3+ years of experience in related field.
* Current states pharmacy license.
PREFERRED CANDIDATE QUALIFICATIONS
License & Credentials: Holds active North Carolina pharmacist license Professional Background: Retail pharmacy experience with strong insurance knowledge, Prior Authorization review experience, PBM (Pharmacy Benefit Manager) background, and managed care experience Technical Skills: MHK RX claims processing and Prime Therapeutics systems familiarity Industry Experience: Rotation as pharmacy student at health plan/managed care organizations and previous contractor role experience Strengths: Team player with collaborative approach, strong understanding of retail pharmacy operations and insurance processes, skilled in reviewing and processing prior authorizations #J-18808-Ljbffr

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