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Position Title: Clinical Pharmacist
Work Location: Remote - National (Preferred: GA, NC, AZ, FL, IN, OK, KS)
Assignment Duration: 3 Months
Work Arrangement: Remote
Position Summary: Define and develop standard and custom formularies for assigned plan.
Key Responsibilities:
Conduct peer-to-peer discussions with prescribers to facilitate timely and appropriate drug therapy decisions for members across all lines of business (Medicaid, Medicare, Exchange, and Commercial).
Handle all reconsideration requests, ensuring compliance with regulatory timelines and clinical appropriateness.
Maintain up-to-date documentation and records of peer-to-peer reviews in compliance with state and federal regulations.
Collaborate with internal teams, including pharmacy technicians, clinical pharmacists, and medical directors to support consistent PA determinations.
Communicate effectively with providers, members, and internal stakeholders regarding PA criteria, denials, and reconsideration outcomes.
Develop, maintain, and provide training on departmental processes and procedural documents related to peer-to-peer reviews and prior authorizations.
Participate in continuous quality improvement initiatives to enhance pharmacy review processes.
Serve as a clinical resource for drug information, therapy alternatives, and benefit coverage guidelines.
Ensure all activities adhere to applicable regulatory standards, including CMS guidelines for Medicare Part D and state-specific Medicaid requirements.
Qualification & Experience:
Bachelor's degree or advanced degree (Pharm.D., M.S.) in pharmacy.
2+ years of mail order, retail, hospital or managed care pharmacy experience or 1+ years of pharmacy residency program experience.
Current state's Pharmacist license with no restrictions.
Required: Pharm.D.
Required Licensure: Licensed in state of residence. Preferred Licensure: GA, NC, AZ, FL, IN, OK, KS.
3+ years' experience.
Disqualifiers: No experience or only retail pharmacy experience.
Additional qualities to look for: PBM preference highly preferred.
Top 3 must-have hard skills stack-ranked by importance:
Excellent communication and interpersonal skills for effective provider engagement.
Experience with pharmacy benefit management systems and electronic PA platforms.
Strong clinical knowledge across multiple therapeutic areas.
Position is offered by a no fee agency.
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Spectraforce Technologies
Aug 02, 2025