Clinical Pharmacist Reviewer- REMOTE

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

The Clinical Staff Pharmacist is responsible for the processing and documenting of Utilization Management requests (e.g. formulary exceptions, prior authorization, step therapy, quantity limit exceptions) for delegated products and services.

Responsibilities

• Process the clinical evaluation for coverage determination requests for prior authorization (PA) or other utilization management (UM) programs, including quantity limits, step therapy, formulary exception and tier exception; this includes consideration of the denial language and appropriateness of the decision as it pertains to the clinical content of the case and the intent of the individual client’s pre-approved criteria
• Consult directly with healthcare providers to address non-formulary and clinical product coverage issues
• Collaborate with team members to ensure consistent decision-making across the pharmacist team
• Respond to medication-related inquiries via phone, providing accurate information to patients, providers, and clinics regarding medications, formulary options, and coverage questions
• Other duties as assigned

Minimum Qualifications

• Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy Degree

• 1 years of work experience in clinical, retail, hospital, or managed care
• Current pharmacist license in good standing with the State Board of Pharmacy

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

• Strong verbal and written communication skills
• Ability to work efficiently with computers and digital tools

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Preferred Qualifications

• Managed care experience

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.  

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.