Pharmacist
Job
Actalent
Remote
$114,400 Salary, Full-Time
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Job Description
Remote Pharmacist Description Candidates will be reviewing Commercial members' Utilization Management (UM) requests (i.e., formulary exceptions, prior authorization, step therapy, quantity limit exceptions). Client-specific criteria are referenced to determine if a prior authorization can be approved or denied. The work is detail-oriented, and candidates will be expected to provide clinical judgement and communication.
- Responsible for the clinical evaluation for coverage determination requests for PA or other UM programs, including quantity limits, step therapy, formulary exception and tier exception, and includes consideration of the denial language and appropriateness of the decision as it pertains to the clinical content of the case and the intent of the individual client's pre-approved criteria
- Accountable for direct consultation with health care providers or members concerning non-formulary and clinical product coverage issues
- Collaborate with team members to promote consistency of decisions across the pharmacist team
- Other duties as assigned Additional Skills & Qualifications Qualifications/years of experience:
- Doctor of Pharmacy (PharmD) or equivalent
- 2+yrs experience working in a retail environment
- Current pharmacist license in good standing with the State Board of Pharmacy in the State where the candidate is licensed.
- Verify by searching (State) State Board of Pharmacy, ex: Oklahoma State Board of Pharmacy (will need license number from pharmacist).
Must Haves:
1. Ability to prioritize tasks and manage multiple projects simultaneously. 2. Drive to deliver results orientation. 3. A motivated self-starter who does not need constant direction or feedback to drive results. 4. Ability to make clinical decisions independently 5. Flexibility to change and resourcefulTechnology Requirements:
- Proficient with learning new computer systems, basic IT trouble shooting and using multiple monitors
- Word and Excel
- Ability to type 45+
WPM Additional Preferred Requirements:
- Previous PBM or Case/Care Management experience.
- Medical, dental & vision
- Critical Illness, Accident, and Hospital
- 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available
- Life Insurance (Voluntary Life & AD&D for the employee and dependents)
- Short and long-term disability
- Health Spending Account (HSA)
- Transportation benefits
- Employee Assistance Program
- Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position.
San Francisco Fair Chance Ordinance:
Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.Massachusetts Lie Detector:
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.Similar remote jobs
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