Clinical Pharmacist

Summary:

The Clinical Pharmacist supports utilization management within a health plan environment by reviewing pharmacy and medical drug requests with a focus on specialty and high-cost therapies. The Clinical Pharmacist ensures coverage determinations are clinically appropriate, evidence based, and compliant with regulatory requirements. The pharmacist also contributes to drug coverage policy development, Pharmacy & Therapeutics (P&T) Committee activities, and clinical programs such as Medication Therapy Management (MTM). Key Responsibilities Review prior authorization requests for medical and specialty drugs using clinical guidelines consistent with CMS and AHCCCS requirements Approve or deny requests with clear clinical rationale and supporting documentation Process coverage determinations, and appeals within required turnaround times Ensure alignment with formulary requirements, step therapy protocols, and utilization management programs Develop and maintain prior authorization criteria, drug coverage policies, and clinical guidelines Review literature and evaluate clinical evidence to support policy updates and new drug evaluations Support formulary development by participating in quarterly P&T Committee meetings and presenting therapy class reviews Translate P&T decisions into coverage policies and PA criteria Support MTM programs aligned with CMS requirements Contribute to quality initiatives, including Medicare Star Ratings Provide support and drug information to providers, care teams, health plan members, and internal stake holders. Collaborate with pharmacists, nurses, case managers, and members to promote appropriate medication use Ensure compliance with CMS and AHCCCS requirements Participate in other job-related projects and clinical initiatives Hours Full-Time Exempt Monday-Friday 9:00 AM - 5:30 PM In-office Compensation Depending on experience Bonus Eligible Benefits PTO Medical, Dental, Vision, Life Insurance 401k retirmement

Pay:

From $60.00 per hour

Benefits:

401(k) 401(k) matching Dental insurance Health insurance Health savings account Life insurance Paid time off Retirement plan Vision insurance Application Question(s): Do you live in Arizona? Are you willing to consent to random drug screens and complete a background check?

Education:

Doctorate (Required)

Experience:

Managed Care, Prior Authorization, or Clinical Pharmacy:

1 year (Required) clinical training such as

Board Certified Pharmacotherapy:

1 year (Preferred) working with Health plan or

PBM:

1 year (Preferred)

CMS, Medicaid, or AHCCCS:

1 year (Preferred) specialty drug management and coverage criteria policy: 1 year (Preferred) group presentation: 1 year (Preferred)

License/Certification:

Unrestricted Arizona Pharmacist License (Required) Ability to

Commute:

Glendale, AZ 85308 (Required)

Work Location:

In person