Clinical Pharmacist 1 Spectraforce Technologies $200.00 United States, North Carolina, Raleigh 500 West Peace Street (Show on map) Aug 26, 2026

Position Title:

Clinical Pharmacist 1

Work Location:

Remote Assignment Duration:

3 months

Work Schedule:

9am - 6pm

EST, No OT Work Arrangement:

Remote Job description:

• Reviews a completed prior authorization request received from the provider and/or reviews the pharmacy technician's recommended denial, suggested formulary alternatives, comments and attachments for appropriateness.
• Verifies member's ID number and date of birth.
• Verifies member's eligibility in the appropriate health plan eligibility system.
• Records carrier and group number if applicable.
• Checks for previous prior authorization decisions.
• Verifies coverage in member's prescription benefit when necessary.
• Verifies coverage in member's health plan benefit when necessary.
• Evaluates prescription claim history.
• Reviews chart notes and/or lab values.
• Identifies provider specialty when appropriate.
• Applies Medical Policy Criteria to prior authorization requests.
• Evaluates whether request meets criteria for approval.
• Reviews the request using professional clinical judgment on a case by case basis. A pharmacist will review medication requests not addressed by P&T Committee criteria or guidelines, develop and draft criteria for the non-formulary medication requested.
• Researches and contributes drug references and clinical information to facilitate prior authorization review: directly to physicians via fax or phone encounter; or to pharmacy technicians via memo or on a personal level as an educational tool
• Communicates with physicians regarding prior authorization: o For a non-formulary drug o Plan benefits, exclusions o Quantity limits o Age restrictions o Formulary alternatives
• Retrieves and collects data through available reporting resources (i.e. Discoverer, IT Department)
• Compiles data for reporting purposes: o Drug utilization of non-formulary drugs o Overturned IPS recommended denials o Audit pharmacy claims greater than $200.

00 o Suggest addition or deletion of drugs to/from the formulary o Updating qty/days or age limit ends o Support National P&T Committee o Other tasks which may arise during the performance of any of the above mentioned duties Candidate Requirements Education/Certification

Required:

Pharm D.

Preferred:

n/a Licensure

Required:

Any US state

Preferred:

n/a Years of experience required Disqualifiers Best vs. average Performance indicators Must haves: At least one year of professional RPh experience Nice to haves: Some experience working in managed care, understanding of Medicare/Medicaid law

Disqualifiers:

n/a Performance indicators:

• Sign 85 - 100 cases daily Top 3 must-have hard skills Level of experience with each Stack-ranked by importance Candidate Review & Selection 1 Self-Motivated/Good Time Management Skills 2 Working Knowledge of Office Suite 3 Goal Oriented