Pharmacy Clinical Review Analyst

Pharmacy Clinical Review Analyst Our client is seeking a detail-oriented Pharmacy Clinical Review Analyst who brings strong analytical thinking, clinical knowledge, and a commitment to accuracy in healthcare auditing. This role is ideal for a professional who thrives in a structured, compliance-driven environment and enjoys investigating complex billing scenarios involving pharmaceuticals and treatments. The successful candidate will demonstrate strong problem-solving abilities, attention to detail, and the ability to work independently while meeting strict quality and productivity standards. This role is fully remote. Applicants who reside in Oregon, Washington, Utah, or Idaho are preferred. Pharmacy Clinical Review Analyst Responsibilities Conduct post-service audits of pharmaceutical and drug-related charges to ensure billed services align with medical records, treatment documentation, and reimbursement policies. Analyze claims and billing documentation to identify discrepancies, incorrect charges, or potentially inappropriate drug usage, including investigational or off-label treatments. Request and evaluate supporting documentation when additional clinical or billing information is required to complete claim reviews. Ensure all reviews comply with internal quality standards as well as applicable federal, state, and accreditation regulations. Maintain organized reference materials and contribute to operational efficiency through cross-training, workflow coordination, and participation in department initiatives or special projects. Pharmacy Clinical Review Analyst Qualifications Licensed Practical Nurse (LPN) or Licensed Pharmacy Technician credential required. Approximately 2+ years of clinical experience in a hospital, residential treatment facility, or similar healthcare setting, along with 3+ years of health insurance claims review, auditing, or analytical experience. Strong knowledge of pharmaceuticals, drug administration, and billing practices to identify inaccurate charges or improper medication usage. Familiarity with healthcare documentation, medical terminology, and claims processing forms, with strong written and verbal communication skills. Proficiency with standard computer tools (e.g., Microsoft Office) and the ability to work in fast-paced environments while meeting productivity and quality standards; experience leveraging AI tools to enhance workflow efficiency is a plus.

Compensation:

(DOE) VanderHouwen Contractors Enjoy Exceptional Benefit Perks! As an eligible contract employee with VanderHouwen, you'll have access to a full suite of benefits designed with your well-being in mind. Our comprehensive package includes medical, dental, vision, life insurance, short- and long-term disability, and a matching 401(k) to help secure your future. Meet VanderHouwen What kind of recruiter do you see yourself working with? One who prioritizes your best interest, no matter what? VanderHouwen does, and we're in it for the long game! Our recruiters focus on YOU, building meaningful, long-term relationships while developing a deep understanding of companies' staffing needs and workplace cultures. This approach helps us find an ideal job match that aligns with your unique career aspirations and goals. VanderHouwen is an award-winning, Women & Diversity-Owned, WBENC certified professional staffing firm. Founded in 1987, VanderHouwen places experienced professionals across the nation! Our recruitment teams specialize in either Technology and IT, Engineering, Human Resources, or Accounting and Finance career markets. Partner with us to land your next exciting career! VanderHouwen is an Equal Opportunity Employer and participates in E-Verify. VanderHouwen does not discriminate based on race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable local, state, or federal civil rights laws. #LI-Remote #AF1 #LI-JB1