Pharmacist

Green Key Resources is representing a health plan who is looking for multiple Pharmacists (Utilization Management) to join their team! This is a remote role, you are able to work remotely in one of the following states: Arizona, California, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, or Washington. Note, this list of states is subject to change.

Hours of operation are 6 AM - 7 PM Central Time. Colleagues can define their schedule with their Team Lead but we expect the schedule to remain static week over week.

Position Summary:

As a Clinical Pharmacist you will play a critical role on the Pharmacy Clinical Review Team as a reviewer of prior authorizations and appeals for our Exchange line of business across all states. This role will also support review and development of new clinical guidelines and serve as an internal pharmacy SME for other teams.

Position Responsibilities:

• Review and render decisions on authorizations and appeals for specialty, non-specialty, and physician administered drugs
• Conduct peer-to-peer calls with prescribers to discuss the clinical rationale of adverse determinations
• Participate in clinical quality audits (inter-rater reliability testing)
• Provide internal team support for escalations and questions from pharmacy technicians and physicians
• Develop and review clinical criteria

Minimum Qualifications:

• For experience, we are looking for someone with managed care experience performing prior authorizations or at least 5 years of experience as a licensed pharmacist (not including intern years). Residency years can count towards the 5 years as they would be licensed during residency. If the candidate completed a managed care residency, we can lower the min year requirement as that residency would specialize in managed care work.
• 3+ years of experience in managed care performing clinical review/utilization management.
• Active, unrestricted pharmacist license
• Doctor of Pharmacy Degree
• Willingness to obtain licensure/training with new states, as needed
• Strong clinical skills and experience applying clinical criteria in clinical review setting
• Ability to obtain and maintain secure, high-speed and consistent internet connectivity

· Salary is based on experience, tenure, certifications etc. (very competitive with market place)

Next Steps:

Looking to interview immediately. If you feel that you meet these requirements and are interested, please APPLY

Job Types: Full-time, Contract

Benefits:

• Dental insurance
• Health insurance
• Vision insurance

Schedule:

• Monday to Friday

Application Question(s):

• What number should we call you at?
• What state do you reside in?
• Do you have a Doctorate in Pharmacy?

Work Location: Remote