What are the responsibilities and job description for the Remote Clinical Pharmacist position at CSI Companies?
Job Summary
The Clinical Pharmacist will play a pivotal role in performing clinical outreach, conducting case reviews, and providing recommendations to Medical Directors. This role is primarily responsible for assessing prescriptions and patient histories, interpreting clinical documentation, and engaging with customers, patients, and physicians to deliver expert clinical insights and decisions.
Pay : $58 – 64 an hour (overtime will be paid at 1.5 times the normal hourly pay rate).
Hours : Full Time - Mon-Fri – 8-5 or 9-6 local time with rotational weekend hours and some holiday coverage
Why this Opportunity?
Top ranked company in Fortune’s 2022 “World’s Most Admired Companies” for over a decade consecutively.
This healthcare client is ranked number one in key attributes of reputation : Innovation People management Social responsibility Quality of Management Financial soundness Long-term investment value Quality of products Services and global competitiveness
Status : Consultant : Starting off as a consultant / contractor there is always potential for long term / conversion for the right employee upon business needs. Almost all of the positions within this client start off as a contractor due to being a Fortune 100 company.
Effective Date / Tentative Start Date : Interviewing Immediately
Job Duties :
Evaluate prescriptions and patient histories to determine appropriateness of medications and treatments
Interpret physicians' prescriptions and clinical documentation, utilizing clinical criteria and compendia support
Consult with customers, patients, and physicians to address inquiries related to medication use, potential drug interactions, and clinical status for appeals requests
Perform Quality Assurance checks and verify the accuracy of all prescriptions to make informed appeal decisions
Provide explanations and interpretations within area of expertise
Review formulary and utilization management guidelines to determine coverage eligibility based on patients' medical histories
Research, evaluate, and make informed determinations on member and provider appeals of pharmacy coverage decisions
Gather complex clinical information, consider approved compendia, medical literature, coverage policy, and criteria information and work within regulatory guidelines to render decisions. Decision may require consulting with Plan Medical Directors and the beneficiaries treating physician
Address inquiries from support personnel regarding prescription drugs and related clinical matters
Maintain meticulous record-keeping, thorough documentation, and communicate clearly and concisely in written and verbal formats
Requirements
Doctor of Pharmacy degree
Valid pharmacist license
Excellent written and verbal communication skills
Proficiency in using online clinical references and accessing professional (clinical and regulatory) internet resources
Familiarity with working with onscreen document images
Intermediate computer skills with proficiency in MS Office and ability to navigate Windows-based environments
A reliable high-speed internet connection (the faster the better)
Ability to pass a background check and drug test
Private, quiet, and distraction-free workspace in a room with a closed-door
Highly Preferred
Large corporation experience
Health plan / managed care / healthcare industry experience.
Pharmacy Benefit Management experience
Pharmacy Residency experience
Experience in Medicaid, Commercial (private), and / or Medicare Part D prescription drug plans, programs, or formularies
Experience in Coverage Determinations (prior authorization) or member appeals
Pharmacy reimbursement (third party insurance, Medicare Part D formulary management, Medicaid) experience
Benefits Offered :
Weekly pay
Medical, dental, and vision coverage
Voluntary Life and AD&D coverage
Paid Training
Opportunity for advancement upon performance and availability
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