Job Description:
Job Title: Clinical Pharmacist 1
Duration: 6 Months
Schedule: Monday to Friday, 8:00 AM 5:00 PM EST
Location: Remote
Position Overview:
We are seeking a Clinical Pharmacist to join Clinical Pharmacy Drug Authorization (CPDA UM) team. This role plays a critical part in managing clinical peer-to-peer reviews with prescribers, ensuring appropriate and timely medication determinations, and upholding compliance with CMS and Medicaid guidelines. The position is intended to temporarily cover an FTE on leave and is not eligible for conversion or extension.
Key Responsibilities:
Conduct peer-to-peer consultations with prescribers across Medicaid, Medicare, Exchange, and Commercial lines of business.
Review and manage all reconsideration requests to ensure compliance with regulatory timelines and clinical standards.
Accurately document peer-to-peer interactions in accordance with federal and state guidelines.
Collaborate with pharmacy techs, clinical pharmacists, and medical directors to align on PA determinations.
Provide clear communication to providers and internal stakeholders regarding clinical criteria and denial justifications.
Serve as a clinical resource for drug information and coverage guidelines.
Participate in continuous process improvement and maintain departmental documentation and SOPs.
Deliver and maintain training related to peer-to-peer processes and PA workflows.
Requirements:
Education: Pharm.D. required.
Licensure: Active pharmacist license with no restrictions (must be licensed in state of residence).
Experience: Minimum 3+ years in clinical pharmacy practice. PBM experience highly preferred.
Disqualifiers: Candidates with only retail pharmacy experience will not be considered.
Top Skills & Qualifications:
Excellent communication and interpersonal skills for engaging effectively with providers.
Experience with PBM systems and electronic prior authorization platforms.
Strong clinical knowledge across multiple therapeutic classes.
Performance Expectations:
Complete 30 40 peer-to-peer calls per day.
Emphasis on clinical quality and accuracy over volume.
Work follows regular MD office hours - no weekends or major holidays.
Find Your Passion and Purpose as a Caregiver & Reimagine Your Career in Home Care As a medical professional, you know that what you do impacts you as much as your clients and their families, and at AccentCare, we are united in our relentless drive to reimagine care because...
As an Executive Housekeeper, you will be responsible for overseeing the housekeeping operations of the hotel, ensuring cleanliness, order, and guest satisfaction. This position can also assist the front desk/guest services when business volume demandsBenefits:* Insurance...
...Key Responsibilities: # Installation and Assembly: Pipe Fitters install new piping systems according to specifications and blueprints, including connecting pipes, valves, and other components. # Fabrication: They may be required to cut, bend, and shape pipes...
...Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community; student; social). You will receive...
...Pediatrics Licensed Speech Language Pathology Assistant (SLPA) - Home Health (Bilingual Spanish Preferred) Aveannas highly skilled pediatric therapy team provides our patients a full range of care to help them make the most of their care or recovery. We offer our industry...