Clinical Pharmacist

Job Description Title:

Clinical Pharmacist

Duration:

6+ months

Location:

Remote in North Carolina

Shift Timing:

M-F 8-5 EST

Job Description:

?Review prior authorization requests and make determinations for drug products according to member benefits and coverage criteria. Report to utilization review statistics to corporate compliance committees. Review data and summarize daily utilization review numbers. Responsible for tracking compliance of review cases. Provide clinical guidance and support to the assigned pharmacy technicians. Knowledge of drug coding (NDC, GCN, GPI and USC) and NCPDP claims adjudication systems. Review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design. Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices. Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews. Engage Medicare members, pharmacies, and providers to close adherence and SUPD (Statin Use in Persons with Diabetes) gaps. Complete Comprehensive Medication Reviews (CMRs) with Medicare members. Make outreach to Medicare members to assist in removing barriers to medication adherence. Partner with pharmacies and providers to close adherence gaps when the Medicare member is unengaged or when the Medicare member requires assistance. Contact providers to close SUPD (Statin Use in Persons with Diabetes) gaps. Complete Comprehensive Medication Reviews (CMRs) with eligible Medicare members to give the member a better understanding of their medications and health. Send interventions to providers through fax or the CMR platform to alert the provider of potential drug interactions and adverse reactions, dose changes, adherence issues, etc. Provide counseling to Medicare members regarding medications. Provide Medicare members with information regarding their pharmacy benefits (ie. formulary, preferred pharmacy, supplemental benefits, etc.) Provide clinical guidance and support to the Pharmacy Quality Specialists.

Hiring Requirements:

Bachelor's degree or advanced degree. 3+ years of experience in related field. NC state pharmacy license and residence. Top 3-4

Required Skills:

Able to work on computers and has work from home experience. Pharmacist experience. High volume call. Nice to have

Skills:

Medicare and Medicaid experience. Health Plan. Managed care experience. MTM/CMR

Years of Experience:

3-5

Education/Certifications Required:

Pharmacist license for the state. Pharm D is preferred. Industry Specific Experience - required, ideal, necessary? Retail, HMO, DSNIP

Breakdown of Duties/Typical Day:

Participating in comprehensive medication review. Cold calling members and reaching out on non adherence. Advocate for member on adherence gaps. Time that you will be on the phone is going to be 3.5 to 4.5 hours a day Do you have screening questions? Do you have any familiarity with Medicare STARs and metrics? If so, please explain. Applicant Notices & Disclaimers For information on benefits, equal opportunity employment, and location-specific applicant notices, click here At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position's starting pay is: $61.80/hr.