Clinical Pharmacist Reviewer- REMOTE

Prime Therapeutics • Home, WV

4d • $52 - $88 • Remote

About The Position

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. 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.

Requirements

• 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
• Excellent verbal and written communication skills
• Ability to work independently and as part of a team
• 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
• Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship.
• In addition, Prime retains the right to change or assign other duties to this job.

Nice To Haves

• Managed care experience
• Proficiency with Microsoft Office

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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level