Job Title: Clinical Pharmacist

Job Description

This position will be the expert of the team on clinical issues, working collaboratively with the Director of Pharmacy and other staff pharmacists. The role involves designing, implementing, maintaining, and measuring pharmacy-related utilization management programs. This includes developing workflows, criteria, and ensuring URAC accreditation is maintained.

Responsibilities

• Develop and maintain clinical criteria for applicable Utilization Management (UM) programs.
• Create and maintain criteria process flows and physician fax forms.
• Utilize predictive modeling tools to intervene with high-risk members for identified disease states.
• Provide clinical updates to internal staff and physician reviewers.
• Perform complex research, analysis, and develop recommendations for UM programs and plan design changes.
• Oversee operational workflows and complete UM reviews.
• Provide clinical support for Pharmacy Technicians and other staff.
• Utilize reporting tools to create efficiencies by reviewing medical and pharmacy claims data.
• Support physician reviewers with information required to review non-approvable claims.
• Develop decision tree review processes when applicable.
• Ensure URAC accreditation is maintained.
• Measure quality assurance reporting, turnaround time for urgent and non-urgent reviews, and quantitative assessment of UM reviews by program.

Essential Skills

• Pharm.D degree
• MUST HAVE a Nebraska Pharmacy License
• Experience with prior authorization and insurance verification
• Knowledge of medical terminology, medical billing, and data entry
• Experience in healthcare and retail pharmacy

Additional Skills & Qualifications

• Certification in Pharmacy Technician (Cpht)
• Experience with Medication Therapy Management (MTM)
• Strong data entry skills

Work Environment

This role is a short term contract. This is a 100% remote role with a shift from 8am-5pm, Monday to Friday. The role offers a collaborative culture focused on innovation and efficiency in pharmacy-related utilization management programs.

Pay and Benefits

The pay range for this position is $60.00 - $70.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• 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.

Application Deadline

This position is anticipated to close on Mar 12, 2025.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

• Hiring diverse talent
• Maintaining an inclusive environment through persistent self-reflection
• Building a culture of care, engagement, and recognition with clear outcomes
• Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.

Salary : $60 - $70