Remote Pharmacist

We are seeking a dedicated Clinical Pharmacist to join our Prior Authorization team within the Customer Service. In this dynamic role, you will be responsible for reviewing Prior Authorization cases and making coverage determinations based on clinical criteria and plan design in a fast-paced environment. You will also collaborate with medical directors to finalize coverage decisions as required by law. This role requires flexibility to adapt to frequent changes and the ability to work effectively as part of a team.

Primary Responsibilities:

Utilize computer systems to receive and manage phone calls from prior authorization pharmacy technicians and providers seeking clinical information.

Consult with physicians and providers, interpret clinical guidelines, and render or review coverage determinations for prior authorization cases.

Provide guidance on medication use and formulary alternatives to pharmacy technicians and physicians.

Demonstrate meticulous attention to detail by gathering complex clinical information and working within regulatory guidelines to make informed coverage decisions.

Organize and prioritize workload, complete assignments timely, and adhere to departmental program standards.

Ensure compliance with state and federal pharmacy laws and regulations in all duties performed.

Support and adhere to department quality assurance and improvement guidelines.

Foster positive relationships with coworkers, internal customers, and other departments, reflecting a strong customer service orientation.

Maintain productive working relationships with team members, internal and external customers, and management.

Prioritize patient safety and quality, ensuring a secure workspace and promptly addressing any safety concerns with leadership.

Resolve issues and complaints efficiently and effectively.

Perform additional duties as assigned by management.

Participate in a 5-week training program, typically scheduled from 8:00 AM to 5:00 PM local time, Monday through Friday, with potential adjustments.

Post-training, work an 8-hour shift with a 1-hour lunch break. Availability is required from 5:00 AM to midnight, with a 5-day workweek that may include weekends and possible overtime or holiday shifts.

Must have a reliable home internet connection (hardwired with Ethernet preferred) and a secure home workspace.

Proficiency in using PC systems, including navigation through multiple screens and applications, is essential.

Demonstrate excellent attendance and reliability.

Required Qualifications:

Bachelor's or Doctorate of Pharmacy and an active state pharmacist license.

Minimum of 6 months of customer service experience, particularly in healthcare settings.

Basic proficiency in Microsoft Excel (creating, editing, and saving spreadsheets), Microsoft Word (creating, editing, and saving documents), and Microsoft Outlook (email communication).

Availability to work from 5:00 AM to midnight, with flexibility for overtime and weekend shifts as needed.

Additional Information:

· Location: Nevada, Arizona, New Mexico, Utah, Montana, Idaho, Oregon and Colorado

· Schedule: Availability is required from 5:00 AM to midnight, with a 5-day workweek that may include weekends and possible overtime or holiday shifts.

· Pay Range: $54.70 - $57.75 per hour

*Offered pay rate will be based on education, experience, and healthcare credentials.

Pride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.

Interested? Apply now!