Our Healthcare Insurance client is seeking a Clinical Pharmacist to join their team for a contract role!
Our client has more than 5,000 employees and is the number 1 health insurer in the state of North Carolina serving more than 3.89 million customers.
Our client's goal is to provide innovative solutions that simplify the health care system, improve efficiency and outcomes, and help rein in costs.
Position: Clinical Pharmacist
Location: Remote work
Term: 6 months
- Provide timely drug therapy for health plan members by reviewing and processing prior authorization requests using clinical judgment and medical policy.
- 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
Is this a fit? (Requirements):
- Experience reviewing prior authorization requests and making determinations for drug products according to member benefits and coverage criteria
- Experience providing clinical guidance to pharmacy techs
- Drug coding knowledge (NDC, GCN, GPI and USC) and NCPDP claims adjudication systems
- Licensed Pharmacist; NC license highly preferred
- Highly Preferred experience in Managed Care