Clinical Pharmacist Overview • The Clinical Pharmacist will review prior authorization requests and determine drug coverage based on member benefits and criteria. • Provide clinical guidance and support to pharmacy technicians, ensuring adherence to compliance and quality standards. • Analyze utilization review statistics and report findings to corporate compliance committees for informed decision-making. • Evaluate and implement opportunities for performance improvement in pharmacy practices and benefit designs. • Maintain up-to-date drug knowledge and disease state understanding for effective prior authorization reviews. • Collaborate with Pharmacy and Therapeutics Committees to review guideline criteria for non-formulary drugs. • Ensure quality control measures are in place and track compliance of review cases effectively. • Work remotely, offering flexibility while contributing to impactful pharmacy operations and member care. Clinical Pharmacist Key Responsibilities & Duties • Review prior authorization requests for drug products and ensure compliance with member benefits and coverage criteria. • Analyze daily utilization review data and summarize findings for reporting purposes. • Track compliance of review cases and implement quality control measures. • Provide clinical guidance and mentorship to assigned pharmacy technicians. • Research drug information to maintain expertise in drug coding and claims adjudication systems. • Collaborate with committees to review guideline criteria for prior authorization and non-formulary drugs. • Evaluate and implement opportunities for performance improvement in pharmacy practices. • Ensure compliance with corporate standards and contribute to strategic pharmacy benefit designs. Clinical Pharmacist Job Requirements • Doctor of Pharmacy (PharmD) degree is required for this position. • Minimum of 3 years of experience in a related field, with 5 years preferred. • Active pharmacy license in the applicable state is mandatory. • Proficiency in drug coding systems (NDC, GCN, GPI, USC) and claims adjudication systems. • Strong analytical skills to summarize utilization review data and track compliance. • Ability to provide clinical guidance and mentorship to pharmacy technicians. • Knowledge of pharmacy benefit design and prior authorization criteria. • Experience in remote work environments and ability to collaborate effectively with teams.