Clinical Pharmacist (Remote, North Carolina)

About the role

This remote Clinical Pharmacist position supports a health‑plan’s utilization review and medication adherence programs for Medicare members across North Carolina. You will work full‑time (M‑F, 8‑5 EST) reviewing prior‑authorization requests, conducting comprehensive medication reviews, and collaborating with pharmacies and providers to close adherence gaps.

Key responsibilities

• Review prior‑authorization and non‑formulary drug requests against member benefits and coverage criteria.
• Generate daily utilization review reports and track compliance metrics for corporate committees.
• Provide clinical guidance to pharmacy technicians and Pharmacy Quality Specialists.
• Research drug information, maintain disease‑state knowledge, and apply it to authorization decisions.
• Engage Medicare members, pharmacies, and providers to resolve adherence and SUPD (Statin Use in Persons with Diabetes) gaps.
• Conduct Comprehensive Medication Reviews (CMRs) and communicate interventions to providers via fax or the CMR platform.
• Educate members on pharmacy benefits, formulary options, and supplemental coverage.

Required profile

• Bachelor’s degree or higher in pharmacy; PharmD preferred.
• NC state pharmacy license and residency.
• 3‑5 years of experience in pharmacy practice, preferably in managed‑care or retail settings.
• Experience with Medicare and Medicaid programs is a plus.

Required skills

• Proficiency with drug coding systems: NDC, GCN, GPI, USC.
• Knowledge of NCPDP claims adjudication processes.
• Prior‑authorization review and utilization management.
• Medicare and Medicaid program familiarity.
• Medication Therapy Management (MTM) and Comprehensive Medication Review (CMR) execution.

What we offer

• Remote work flexibility within the EST time zone.
• Competitive compensation for a fixed‑term engagement (6+ months).
• Opportunities to impact member health outcomes and pharmacy practice quality.