Clinical Pharmacist Reviewer- REMOTE

Our work matters. We help people get the medicine they need to feel better and live well.  We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Clinical Pharmacist Reviewer- REMOTE

Job Description

The Clinical Staff Pharmacist is responsible for the processing and documenting of Utilization Management requests (i.e. formulary exceptions, prior authorization, step therapy, quantity limit exceptions) for delegated products and services.

Responsibilities

• Responsible for 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
• Accountable for direct consultation with health care providers concerning non-formulary and clinical product coverage issues
• Collaborate with team members to promote consistency of decisions across the pharmacist team
• Other duties as assigned

Education & Experience

• Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy Degree
• Current pharmacist license in good standing with the State Board of Pharmacy
• 2 years of clinical experience; or equivalent training, education and/or experience
• Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

• Excellent verbal and written communication skills
• Ability to work independently and as part of a team

Preferred Qualifications

• Managed care experience
• Proficiency with Microsoft Office

Physical Demands

• This position may require rotation through weekend and/or holiday schedules
• Constantly required to sit, use hands to handle or feel, talk and hear
• Frequently required to reach with hands and arms
• Occasionally required to stand, walk and stoop, kneel, and crouch
• Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Reporting Structure

• Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Potential pay for this position ranges from $51.92 - $88.46 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.   

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.

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