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.
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