Pharmacist

Clinical Review Pharmacist (100% Remote, Entry-Level)

We are seeking a dedicated Clinical Review Pharmacist to join our team in a fully remote capacity. You will be responsible for reviewing utilization management requests and making informed decisions based on client-specific criteria. This role requires precision, clinical judgment, and effective communication with healthcare providers and team members.
Responsibilities

+ Review and evaluate commercial members’ utilization management requests, including formulary exceptions, prior authorization, step therapy, and quantity limit exceptions.

+ Utilize client-specific criteria to determine approval or denial of prior authorizations.

+ Conduct clinical evaluations for coverage determination requests, considering denial language and decision appropriateness.

+ Consult directly with healthcare providers or members on non-formulary and clinical product coverage issues.

+ Collaborate w...