Per Diem Pharmacist

Key Responsibilities

• Clinical Review & Determinations
• Review, evaluate, and resolve all assigned clinical reviews through comprehensive case review and direct physician engagement aligned with EmpiRx Health’s Population Health Management model.
• Perform peer-to-peer reviews with providers as needed or when requested.
• Convey clinical determinations promptly within established turnaround time requirements to prescribers, members, and healthcare professionals following established approval and denial protocols.
• Clinical Oversight & Quality Assurance
• Monitor and proactively identify clinical interventions to ensure clinical savings guarantees are met.
• Review and evaluate current clinical literature to support recommendations and decision-making.
• Participate in continuous quality improvement initiatives to streamline clinical review processes and enhance member care.
• Stay informed on EmpiRx Health formulary updates, clinical programs, and internal policies.
• Collaboration & Communication
• Provide guidance and support to members, providers, and other healthcare professionals regarding clinical inquiries.
• Collaborate with clinical technicians and prior authorization team members to facilitate clinical review requests, resolve escalations, and answer inquiries.
• Act as a clinical resource for internal staff, supporting staff training and development as needed.
• Technology & Documentation
• Proficiently utilize pharmacy management software for case documentation and communications.
• Proficiently utilize Microsoft Office tools to support analysis and reporting.
• Utilize external clinical and drug information resources (e.g., IPD, Policy Reporter, UpToDate, MediSpan) to support reviews, decisions, and awareness of emerging drugs.
• Collaborate cross-functionally with internal clinical teams for claim/data review, clinical interventions, and provider/member/client support as required.

Qualifications & Requirements

• Pharm.D. degree from an accredited college of pharmacy (Required).
• Minimum of 3 years of pharmacy experience in clinical, PBM, or managed care settings.
• Prior experience with prior authorization, utilization management, or health plan operations preferred.
• Active Pharmacist License in good standing (Required).