Clinical Review Pharmacist (REMOTE)

Clinical Pharmacist is responsible for processing and documenting Utilization Management (UM) requests such as prior authorization, step therapy, and formulary exceptions for delegated products and services. Responsibilities include clinical evaluation and determination of UM requests, evaluating denial language, ensuring decisions align with program criteria, direct consultation with health care providers on non-formulary and clinical product coverage issues, and collaboration with team members to ensure consistency of clinical decisions across the pharmacist team. Positions available in Medicare and Commercial lines of business. Qualifications include a PharmD or BS in Pharmacy with an active pharmacist license; ability to make independent clinical decisions; strong prioritization and multitasking skills; self-motivated with adaptability to a dynamic environment; proficiency with new computer systems and multiple monitors.