Job Description
Job Title: Pharmacist
About the Company: Health technology company providing claim administration and technology solutions for carriers, health plans, TPAs, employer groups, and government entities. As a public benefit corporation, they are executing its mission to materially reduce healthcare costs as a full-service PBM and through the deployment of their unified adjudication systemheir unified adjudication system, the company's cloud-native enterprise health platform. The platform connects every aspect of the healthcare ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, they are re-imagining the administration of benefits and rebuilding trust in healthcare.
Position Summary: The Clinical Care Pharmacist plays a vital role in promoting safe, effective, and appropriate medication use. This position is responsible for reviewing prior authorization requests, supporting clinical programs, and providing expert guidance to members, providers, and pharmacies. The role combines clinical decision-making with a strong focus on service excellence in a fast-paced, collaborative environment.
Position Responsibilities: - Review and make timely, evidence-based decisions on prior authorizations, appeals, and override requests using clinical guidelines and benefit criteria.
- Ensure compliance with federal, state, and internal regulations across Commercial, Exchange, Medicare, and Medicaid plans.
- Accurately document clinical decisions and maintain thorough records in accordance with regulatory and accreditation (URAC/NCQA) utilization review standards.
- Provide clear, empathetic support to members, prescribers, and pharmacies by responding to clinical inquiries via phone, demonstrating professionalism, active listening, and a patient-centered approach.
- Stay current with clinical prescribing guidelines, internal policies, and regulatory changes, and apply them to daily responsibilities.
- Follow all internal procedures, job aids, and HIPAA guidelines to protect patient privacy and data security.
- Identify and report potential fraud, waste, and abuse.
- Support training and development of new and existing team members as needed.
- Assist leadership with special projects, process improvements, and operational initiatives
Minimum Qualifications: - Active, unrestricted, pharmacist license
- Bachelor's or Doctor of Pharmacy degree
- Minimum of 2 years of pharmacy practice experience
- Must have experience in managed care or pharmacy benefit management (PBM)
- Prior Authorization experience
- Strong communication, writing, and organizational skills
- Ability to manage multiple priorities in a high-volume, metric-driven environment
- Availability to work after hours, weekends, and holidays on a rotating schedule
Salary Range: $125,000 USD (40 hours)
Location: Remote
Start Date: 10/6 and TBD in Nov.
Work Hours: - 7a-4p EST
- 9a-6p EST
- 11a-8p EST
- 2p-11p EST
Training Hours: 1 month from 9am-6pm EST
We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
Job Tags
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