Clinical Review Pharmacist (Fully Remote)

12 month Contract role with potential to go permanent Fully remote for now possible but possibility to turn Hybrid in office 2 days a week in Durham come January 2027 MUST live within a commutable distance to Durham M-F 9-5 EST hours, can live in other time zones but work those EST hours • Call Center, PBM, or Retail experience • Must have an understanding of Medicare STARS and Metrics • Must be comfortable on the phones interacting with members • Review prior authorization requests and make determinations for drug products according to member benefits and coverage criteria • Report to utilization review statistics to corporate compliance committees • Review data and summarize daily utilization review numbers • Responsible for tracking compliance of review cases • Provide clinical guidance and support to the assigned pharmacy technicians • Knowledge of drug coding (NDC, GCN, GPI and USC) and NCPDP claims adjudication systems • Review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design. • Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices • Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews Hiring Requirements • Bachelor's degree or advanced degree • 3+ years of experience in related field. • Current states pharmacy license. Apply tot his job Apply To this Job