Clinical Pharmacist (Remote) (Medicare or Managed Care)
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 Now
Apply Now
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 Now
Apply Now