New 
Clinical Pharmacist 1
 Spectraforce Technologies | |||||||||||||||||
 United States, North Carolina, Raleigh | |||||||||||||||||
| 500 West Peace Street (Show on map) | |||||||||||||||||
 Jul 15, 2026 | |||||||||||||||||
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Position Title: Clinical Pharmacist 1
Work Location: Remote Assignment Duration:3 Months (potential for extension and conversion) Shift: 9 am - 6pm EST No OT Job Description: * Reviews a completed prior authorization request received from the provider and/or reviews the pharmacy technician's recommended denial, suggested formulary alternatives, comments and attachments for appropriateness. * Verifies member's ID number and date of birth. * Verifies member's eligibility in the appropriate health plan eligibility system. * Records carrier and group number if applicable. * Checks for previous prior authorization decisions. * Verifies coverage in member's prescription benefit when necessary. * Verifies coverage in member's health plan benefit when necessary. * Evaluates prescription claim history. * Reviews chart notes and/or lab values. * Identifies provider specialty when appropriate. * Applies Medical Policy Criteria to prior authorization requests. * Evaluates whether request meets criteria for approval. * Reviews the request using professional clinical judgment on a case by case basis. A pharmacist will review medication requests not addressed by P&T Committee criteria or guidelines, develop and draft criteria for the non-formulary medication requested. * Researches and contributes drug references and clinical information to facilitate prior authorization review: directly to physicians via fax or phone encounter; or to pharmacy technicians via memo or on a personal level as an educational tool
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