What are the responsibilities and job description for the Pharmacist - Clinical Pharmacist position at CTC?
Job Summary (List Format):
- 100% remote, work-from-home position
- Responsible for reviewing and resolving Medicare-Medicaid coverage determination/redetermination requests
- Conduct clinical reviews for coverage determinations, redeterminations, and global exceptions
- Review and process requests not clearly approvable based on established criteria
- Monitor and improve the quality and efficiency of the prior authorization process
- Draft and review denial language and communicate with prescribers and members as needed
- Recommend medication regimen improvements to physicians
- Collaborate with the coverage determination pharmacy team on process improvement initiatives
- Complete all required annual NCQA training
- Respond to pharmacy-related inquiries from internal teams and member services
- Maintain communication with other departments and functional areas
- Stay updated on the latest clinical literature and guidelines and share with program development teams
- Requires a Pharm D. degree and an active, unrestricted pharmacy license in the resident state
- Previous clinical pharmacy and prior authorization experience preferred
- Must possess basic computer skills and strong organizational, interpersonal, and detail-oriented abilities
- Standard work schedule: Monday–Friday, 9:00 AM–5:30 PM
Recruiter Contact: Shaola Pera, shaola.pera@ctcworld.comAbout Computech Corporation
- 100% remote, work-from-home position
- Responsible for reviewing and resolving Medicare-Medicaid coverage determination/redetermination requests
- Conduct clinical reviews for coverage determinations, redeterminations, and global exceptions
- Review and process requests not clearly approvable based on established criteria
- Monitor and improve the quality and efficiency of the prior authorization process
- Draft and review denial language and communicate with prescribers and members as needed
- Recommend medication regimen improvements to physicians
- Collaborate with the coverage determination pharmacy team on process improvement initiatives
- Complete all required annual NCQA training
- Respond to pharmacy-related inquiries from internal teams and member services
- Maintain communication with other departments and functional areas
- Stay updated on the latest clinical literature and guidelines and share with program development teams
- Requires a Pharm D. degree and an active, unrestricted pharmacy license in the resident state
- Previous clinical pharmacy and prior authorization experience preferred
- Must possess basic computer skills and strong organizational, interpersonal, and detail-oriented abilities
- Standard work schedule: Monday–Friday, 9:00 AM–5:30 PM
Recruiter Contact: Shaola Pera, shaola.pera@ctcworld.comAbout Computech Corporation
As a workforce provider with over 20 years of experience, we are proud to directly employ over 1,500 people around the world and have a role in connecting thousands more with work through our global network of talent suppliers and partners. Visit us at www.computechcorp.com
Computech is an equal opportunity employer including, but not limited to, Minorities, Females, Individuals with Disabilities, Protected Veterans, Sexual Orientation, Gender Identity and is committed to employing a diverse workforce. Equal Employment Opportunity is The Law.
Salary : $63