Clinical Pharmacist - 173866

Responsibilities

• Evaluate prior authorization and coverage review requests by applying clinical guidelines, plan benefits, and formulary requirements to determine medication eligibility.
• Monitor utilization management activities, analyze pharmacy review metrics, and prepare reports supporting compliance and operational objectives.
• Serve as a clinical resource for pharmacy technicians by providing guidance on pharmacy benefit policies, drug therapies, and review processes.
• Conduct research on medications, treatment protocols, and disease state management to support coverage decisions and formulary initiatives.
• Identify opportunities for quality improvement within pharmacy operations and assist with implementing process enhancements to improve accuracy and efficiency.

Qualifications

• Active North Carolina Pharmacist license and current residence within North Carolina.
• Minimum of 3 years of pharmacist experience with a background in retail pharmacy and Medicare Part D programs.
• Previous telephonic experience working for a Health Insurance Company, Managed Care Organization, or Pharmacy Benefit Management environment.
• Strong knowledge of pharmacy claims adjudication, NCPDP systems, and drug coding classifications including NDC, GCN, GPI, and related standards.
• Bachelor's degree in Pharmacy, PharmD, or advanced healthcare-related degree with demonstrated stability and long-term success in contract-based roles.

Pay

Hourly Rate: $50-$60

Benefits

• Comprehensive Benefits: Medical, Dental, Vision, 401(k), Sick Leave (as required by law), and Paid Holidays