Job Description
Job Title: Pharmacist
Duration: 03+ months
Location: Fully Remote
Shift: Day 5x8-Hour (08:00 - 05:00) EST
Role Overview
- The Pharmacist is responsible for dispensing prescription medications to patients and offering expertise in the safe use of prescriptions. This r
- ole includes conducting health and wellness screenings, providing immunizations, overseeing medications given to patients, and advising on healthy lifestyles. The position operates remotely and does not involve direct member-facing duties or work within a partnered clinical facility.
Responsibilities :
- Reviews a completed prior authorization request received from the provider and/or reviews the pharmacy technician's recommended denial, suggested formulary alternatives, comments and attachments for appropriateness.
- Verify member's ID number and date of birth.
- Verifies member's eligibility in the appropriate health plan eligibility system.
- Records carrier and group number if applicable.
- Checks for previous prior authorization decisions.
- Verifies coverage in member's prescription benefit when necessary.
- Verifies coverage in member's health plan benefit when necessary.
- Evaluates prescription claim history.
- Reviews chart notes and/or lab values.
- Identifies provider specialty when appropriate.
- Applies Medical Policy Criteria to prior authorization requests.
- Evaluates whether request meets criteria for approval.
- Reviews the request using professional clinical judgment on a case-by-case basis. A pharmacist will review medication requests not addressed by P&T Committee criteria or guidelines, develop and draft criteria for the non-formulary medication requested.
- Researches and contributes drug references and clinical information to facilitate prior authorization review: directly to physicians via fax or phone encounter; or to pharmacy technicians via memo or on a personal level as an educational tool.
- Communicates with physicians regarding prior authorization:
- For a non-formulary drug
- Plan benefits, exclusions.
- Quantity limits
- Age restrictions
- Formulary alternatives
- Retrieves and collects data through available reporting resources (i.e., Discoverer, IT Department)
- Compiles data for reporting purposes:
- Drug utilization of non-formulary drugs
- Overturned IPS recommended denials.
- Audit pharmacy claims greater than $200.00.
- Suggest addition or deletion of drugs to/from the formulary.
- Updating qty/days or age limit ends
- Support National P&T Committee
- Other tasks which may arise during the performance of any of the above-mentioned duties.
- Performance Expectations
- Case Signing: Sign 85-100 cases daily.
- First Day Experience
- Orientation: Orientation of department and systems.
- Required Skills and Experience
- Pharmacy Experience: Any setting (clinical/retail background helpful).
- Education: Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy degree.
- Certifications: Current pharmacist license in good standing with the State Board of Pharmacy.
- Preferred Skills and Experience
- Software Skills: Proficiency with Office Suite.
- Additional Information
- Work Environment: Remote
- Internal/External Groups: No direct member-facing or partnered clinical facility work.
Job Tags
Shift work,