Pharmacist Job at Allmed Staffing Inc, Maryland

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  • Allmed Staffing Inc
  • Maryland

Job Description

Job Description

Job Description

Large managed care company is looking for an Pharmacist to perform pharmacy appeals case review for a contract position.


WORK LOCATION: FULLY REMOTE

PAY: $60.00

CONTRACT DATES: 1/13/25 - 6/30/25

HOURS: M-F, 8-5

RESPONSIBILITIES

  • Evaluate prescriptions and patient histories
  • Interpret physicians' prescriptions and clinical documentation, accesses clinical criteria and compendia support
  • Consult with customers, patients and/or physicians regarding use of medications, potential drug interactions, and clinical status for appeals requests
  • Conduct Quality Assurance and verify the accuracy of all prescriptions to render appeal decision
  • Provide explanations and interpretations within area of expertise
  • Review formulary and utilization management guidelines to determine if the drug should be a covered benefit for the beneficiary based on their medical history
  • Research, evaluate, and make determinations on member and provider appeals of pharmacy coverage decisions
  • Answer questions from support personnel regarding prescription drugs

QUALIFICATIONS

  • Active, unrestricted Pharmacist license in your state of residence
  • 2+ years of working experience as a licensed Pharmacist
  • Experience using online clinical references and accessing professional (clinical and regulatory) internet sites
  • Prior authorization/appeals review background
  • Excellent written and verbal communication skills
  • Experience working with onscreen document images
  • Intermediate computer proficiency with MS Office and must have the ability to navigate a Windows based environment

PREFERRED QUALIFICATIONS

  • Pharmacy Residency experience
  • PBM experience
  • Pharm D
  • Experience in Medicaid, Commercial (private), and/or Medicare Part D prescription drug plans, programs, or formularies
  • Experience in Coverage Determinations (prior authorization) or member appeals
  • Pharmacy reimbursement (third party insurance, Medicare Part D formulary management, Medicaid, and Commercial experience

Job Tags

Contract work, Work experience placement,

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