Remote NM Licensed Pharmacist

Job Description

The Clinical Specialist role is centered around managing the accessibility, quality, and cost-effectiveness of drug and medical therapy for members and providers. The position emphasizes cost-effective, rational drug and disease therapy through distinct management and cross-departmental functions.

Responsibilities

• Provide clinical support services to client plans contracting for clinical services.
• Perform clinical review, analysis, recommendation, decision, and documentation of prior authorization requests, medical exception requests, and appeal requests.
• Review medication request guidelines for clinical appropriateness and operational efficiency.
• Assist in the revision and creation of new or existing medication request guidelines.
• Provide drug information support and research clinical literature documentation to support prior authorization decisions.
• Prepare Pharmacy and Therapeutics meeting agendas and associated materials, including clinical and financial reviews.
• Coordinate and assist in the preparation of utilization and compliance reporting for client plans.
• Ensure timely preparation and review of plan data and client presentations.
• Coordinate and assist with projects associated with prior authorization program development, implementation, and communications.
• Provide feedback and in-service education to Prior Authorization Coordinators regarding PA guidelines and commonly seen diagnoses.

Essential Skills

• Pharmacy degree (Pharm. D.) or equivalent.
• Unrestricted Registered Pharmacist license in New Mexico.
• Five plus years of related experience and/or training.
• Knowledge of Medicaid, MTM, Medicare, retail pharmacy, insurance verification, and pharmacy benefits management.
• Proficiency in Microsoft Office Suite.

Additional Skills & Qualifications

• Previous PBM (Pharmacy Benefits Management) experience preferred.
• Experience in retail, hospital, or long-term care is beneficial.
• Excellent working knowledge of pharmacy services with an emphasis on managed health care.
• Expertise in clinical application of pharmacy practice.

Work Environment

This is a completely remote work-from-home position. Candidates need a quiet workspace and a high-speed internet connection.

Shifts require availability between 6 AM and 6 PM for an 8-hour workdayt. The role includes a $400 bonus after 90 days to cover potential accessory equipment costs. The company offers a robust training program, and there is a high success rate of conversion to permanent positions. Benefits eligible after the contract period include medical, dental, vision, wellness programs, paid time off, company-paid holidays, incentive compensation, 401K with company match, life and disability insurance, tuition reimbursement, and employee referral bonus.