Remote Clinical Pharmacist

Company: Rx Relief
Location: Commerce City
Posted on: April 8, 2021

Job Description:

JOB DESCRIPTION Remote Clinical Pharmacist (Pharmacy Benefit Management) Attention Pharmacists:Are you ready for a great new remote opportunity?Join one of the nation's leading pharmacist placement firms! Right now, Rx relief has a great opportunity for an experienced Clinical Pharmacist (Pharmacy Benefit Management) . Voted Best of Staffing by both clients and talent, we are a specialty staffing company providing supplemental pharmacy professionals for all pharmacy practice settings. We have an opening for a Clinical Pharmacist (Pharmacy Benefit Management). As a member of our team, you'll enjoy a customized approach to your career needs as well as comprehensive benefits! Join our dynamic team, apply today!With a salary starting at $57.00 Per Hour *, Rx relief is looking for the right person to fill a Clinical Pharmacist (Pharmacy Benefit Management) position---right now.Rx relief offers a range of various benefits including: health insurance, vision and dental insurance, 401(k) and deferred compensation programs, and more!As a Clinical Pharmacist (Pharmacy Benefit Management) , you will track coverage determination requests for approvals, and provide support and input to clinical programs, including health management, drug utilization review, formulary development, pain management and prior authorization programs. Your goals will be to encourage appropriate, high quality, cost effective drug therapy, and to identify opportunities for improvement in efficiency, accuracy and appropriateness of the programs in place.*Salary dependent upon experienceClinical Pharmacist (Pharmacy Benefit Management) Job Specifics and Requirements- Area: Anywhere Licensure Requirements: Must have open, active, and in good standing TX, OK, TN--State Pharmacist License. All are not required but preferred.Education: PharmD. Years of Experience: 1+ Years. Pain Management background preferred Schedule: M-F 40 hours per week. Schedule--depends on the pharmacy needs. Time zone is Central Time. Length of Assignment: Temporary ongoing Pay: $57.00 per hour Equipment: Desktop or Laptop with high speed internet of 50+--megabits required. Calls are web-based. Background/ Drug Requirements: Ability to successfully complete background check and drug screenClinical Pharmacist (Pharmacy Benefit Management) Job Responsibilities: [j1] 21 reviews per month are required. Participate in the coverage determination process (certification, prior authorization, medical exception, exception to coverage, etc.), by reviewing all requests which are not clearly approvable based on specified criteria (algorithms).Make all coverage denial determinations, identifying yourself by first name, title, and responsibility in relation to drug utilization management program administration.Continually monitor the quality and efficiency of the coverage determination process, including coverage criteria, denial language and communication with prescribers.Provide input to clinical content for new and existing programs.Complete all annual URAC training requirements.Participate with core teams working on new program and/or product development.Facilitate communication with and education of clients, members and internal staff regarding daily clinical issues and objectives.Provide support to operational departments on the implementation of various PBM programs and functions, as part of member/patient quality of care.Provide support and clinical expertise related to formulary decisions made by the Pharmacy and Therapeutics Committee.Review health care survey data for Medicare Part D qualified participants and/or perform phone consultations with Med-D enrollees; aid in documentation of calls; designate enrollees for repeat interaction.Assist customer care, client services and other internal customers in responding to and resolving pharmacy-related inquiries from members, clients, providers or pharmacies.Maintain open lines of communication with other functional areas/departments.Participate in multi-departmental meetings and committees to accomplish projects.Responsible for staying current with clinical literature and guidelines, and relaying such to program development core teams.Review specialty medication prior authorization requests (i.e. biopharmaceuticals) according to established treatment protocols, clinical criteria and member benefits.Make coverage determinations within the defined turnaround times, and meet regulatory requirements.Responsible for clinical criteria for specialty medications including analysis, monitoring of industry trends.Develop criteria recommendations for the Pharmacy and Therapeutics Committee, and clients.Define and coordinate prior authorization and drug utilization reviews reports for clients, and ensure that all regulatory reporting requirements for drug utilization review, fraud and abuse reporting are met.Oversee drug utilization review and medication therapy management programs for specialty medications within the assigned plan to meet regulatory requirements; develop systematic reviews of prescription claims to meet strategic initiatives.Develop and design specialty medication clinical edits for claims adjudication and enhanced drug utilization review.Provide clinical guidance, support and oversight to the assigned pharmacy technicians.Develop and 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 practice specific to specialty pharmacies.Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews.Responsible for maintaining productivity and quality standards, as well as legal and company compliance.About Rx relief Rx relief is a specialty staffing company providing supplemental pharmacy professionals for all pharmacy practice settings. Voted Best of Staffing by both clients and talent, we provide a customized approach to your career needs as well as comprehensive benefits. Contact us to learn why everything we do is all about YOU!Compensation / Pay Rate (Up to): $57.00 Per Hour

Keywords: Rx Relief, Commerce City , Remote Clinical Pharmacist, Healthcare , Commerce City, Colorado