Clinical - Clinical Pharmacist 1 - 210392 Job at Pacer Group, Houston, TX

OHRGNGoxVCtRazBPcnE3aWtzNTBlUDN3WVE9PQ==
  • Pacer Group
  • Houston, TX

Job Description

Job Title: Clinical Pharmacist I
Duration: Contract (3 Months)
Location: Remote
Schedule: Monday Friday | 9:00 AM 6:00 PM EST

Pay Range: $60 - 65/hourly

Job Summary

We are hiring a Clinical Pharmacist I to join a remote Pharmacy Appeals team. In this role, you will review prior authorization and appeal requests to help ensure members receive the right medications based on clinical guidelines and health plan policies. You will work with healthcare providers, pharmacy technicians, and internal teams to make accurate and timely coverage decisions.

Key Responsibilities

  • Review prior authorization and appeal requests for prescription medications.
  • Evaluate clinical information, medical records, and pharmacy claims.
  • Review pharmacy technician recommendations and make final clinical decisions.
  • Verify member eligibility and prescription benefits.
  • Apply clinical guidelines and health plan policies when reviewing requests.
  • Communicate with healthcare providers regarding medication coverage, formulary alternatives, and prior authorization decisions.
  • Review non-formulary medication requests and provide clinical recommendations.
  • Research drug information and use clinical resources to support decisions.
  • Assist with formulary updates and pharmacy reports when needed.
  • Maintain accurate documentation and follow company, state, and federal pharmacy regulations.
  • Meet daily productivity and quality goals.

Required Qualifications

  • Doctor of Pharmacy (PharmD) degree.
  • Active Pharmacist (RPh) license in good standing in any U.S. state.
  • At least 1 year of pharmacist experience.
  • Strong clinical knowledge and attention to detail.
  • Good communication and organizational skills.
  • Ability to work independently in a remote environment.
  • Basic knowledge of Microsoft Office.

Preferred Qualifications

  • Experience in managed care, health plans, or pharmacy benefit management (PBM).
  • Knowledge of Medicare and Medicaid guidelines.
  • Experience with prior authorization or pharmacy appeals.

Required Skills

  • Clinical pharmacy knowledge
  • Prior authorization review
  • Medication evaluation
  • Clinical decision-making
  • Time management
  • Communication skills
  • Microsoft Office
  • Attention to detail
  • Organization
  • Problem-solving

Performance Expectations

  • Review 85 100 cases per day while maintaining quality and accuracy.
  • Complete reviews within required turnaround times.
  • Make clear and accurate clinical decisions based on guidelines.

Job Tags

Hourly pay, Contract work, Work at office, Remote work, Monday to Friday

Similar Jobs

MCNC

Network Architect/Engineer Route/Switch & Optical Job at MCNC

 ...Job Summary Join MCNCs Network Architecture and Management team to help support network architecture-based initiatives and the...  ...networking are being followed. # Participates or leads in Pre-Sales Engineering activities as required. # Participates or leads in the... 

European Wax Center

Wax Specialist Job at European Wax Center

 ...European Wax Center, the premiere speed waxing franchise in the beauty industry, is hiring estheticians or cosmetologists. EWC is locally owned and operated by an involved female entrepreneur with more than 15 years' experience in the beauty industry. We promote a professional... 

Commonwealth Senior Living at East Paris

Concierge Job at Commonwealth Senior Living at East Paris

 ...comfortable with a multi-line telephone system, answering, taking messages and transferring calls. Good physical and mental health; PPD screening required. Must have an interest in people, especially the geriatric population. Ability to work without close... 

Bertera Subaru of Hartford

Automotive Technician Job at Bertera Subaru of Hartford

 ...We are seeking an experienced Automotive Technician to join our team. The ideal candidate will have a minimum of 2 years of automotive repair experience and possess strong diagnostic skills. This individual should be proficient in performing routine vehicle maintenance... 

Catholic Charities of the Archdiocese of Newark

FT Residential Counselor - Jersey City Job at Catholic Charities of the Archdiocese of Newark

 ...understanding the necessity for communicating and coordinating works efforts with other employees and organizations Requirements: Bachelor's Degree in Mental Health or Social Services field OR Bachelors Degree in another field and 1 year related experience OR High...