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.
...further! UPMC is thrilled to announce exciting opportunities for Sr. Police Officer II at UPMC Altoona Assigned shift will be based upon... ...will be subject to a thorough background and criminal record check.+ Must be available for all shifts.+ Officers are required...
...employees are expected to comply with wearing face coverings at all times while on the premises to prevent the spread/contraction of... ...considerations: We provide all PPE. Schedule Afternoon/Night Shift Flexible Schedule Weekend Schedule Benefits ~ On the...
JOB SUMMARY: We are looking for a Controller to join our growing team! The right candidate will have previous automotive Controller experience and strong analytical ability. The day-to-day duties of this role include preparing monthly budgets, reviewing financial statements...
Hotel Director Of Housekeeping Location Warner Robins, GA : We're hiring a housekeeping manager to provide excellent sanitation and customer service to our hotel guests. You'll be responsible for leading the housekeeping staff, ensuring team members perform their job duties...
...Shootday, a global photography, videography, and production platform, is looking for talented event photographers to join our freelance network. Job Overview: As an event Photographer and Videographer, you'll capture memorable moments at various events and deliver...