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Clinical Pharmacist Summary: Responsible for the clinical review and medical necessity determination for medical injectable prior authorizations requested for the outpatient setting. This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company.
- Research and apply clinical expertise relative to drug policies and clinical records during medical injectable prior authorization reviews
- Support the clinical review of medical injectable drugs through approvals and denials of services requested (as permitted by state/federal law or state/federal program contracts) based on medical necessity criteria, and coordinate with Ingenio Rx or Anthem medical directors as needed.
- Implementation and execution of outpatient specialty medical injectable clinical programs such as Step Therapy, Dose and Site of Care.
- Partner with other pharmacists to support departmental education and training
- Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh).
- Minimum 2 years of managed care pharmacy, pharmacy benefit management (PBM) experience; or any combination of education and experience, which would provide an equivalent background required.
- At least 3 years’ experience working with (PBM) pharmacy benefit management operations, or an equivalent background preferred.
- Experience working with government programs (Medicare and/or Medicaid) strongly preferred.
- Experience in prior authorizations preferred.
- Oncology prior authorization review experience preferred
- Medical Injectable specialty drug knowledge preferred.
- PharmD preferred.
- Direct clinical program development experience preferred
- 1st and 2nd shift schedules along with weekend and holiday rotations are required.
Day shifts available
Work from home opportunity - Apply from anywhere in the US
Health, dental, vision, life, disability, retirement, and more is available
Eligible CareerGig freelancers get access to affordable guaranteed-issue health, dental, vision, life, and disability insurance, as well as other benefits such as retirement and more.
What's more, CareerGig contributes a portion of our fees towards your benefits. You can learn more about CareerGig benefits here.
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CareerGig (Digics, Inc.) is an equal opportunity employer.