Clinical Pharmacist: Part-Time

About the role

The part-time Clinical Pharmacist is responsible for providing clinical pharmacy support for utilization management, prior authorization, medication management, and care plan development. This role evaluates medication requests using evidence-based clinical criteria, develops individualized care plans, and collaborates with healthcare providers and internal teams to support safe, effective, and cost-conscious medication use.

The Clinical Pharmacist will work closely with pharmacy operations, medical management, analytics, and other clinical teams to support quality outcomes, appropriate medication utilization, and compliance with applicable clinical and regulatory requirements.

What you'll do

Prior Authorization & Utilization Management

• Conduct clinical reviews of prior authorization requests using established clinical criteria, guidelines, and policies.
• Evaluate requests for appropriate use based on diagnosis, medication history, treatment guidelines, and plan benefits.
• Apply utilization management criteria, including prior authorization, step therapy, quantity limits, and specialty pharmacy requirements.
• Communicate with prescribers and healthcare providers to obtain additional clinical information when needed.
• Document clinical determinations and rationale accurately and in accordance with established workflows and regulatory requirements.
• Escalate complex or non-routine cases to appropriate clinical leadership.

Care Plan Development

• Develop and maintain individualized medication-related care plans based on member needs, clinical history, medication use, and identified gaps in care.
• Identify opportunities to improve medication adherence, safety, effectiveness, and outcomes.
• Recommend appropriate medication interventions and follow-up activities.
• Collaborate with providers and other members of the care team to support implementation of care plans.
• Monitor member progress and update care plans as clinically appropriate.

Quality & Process Improvement

• Support clinical quality initiatives designed to improve member outcomes and medication utilization.
• Identify opportunities to improve prior authorization and clinical pharmacy workflows.
• Monitor assigned quality and productivity metrics.
• Participate in clinical and operational process improvement projects.

Documentation & Compliance

• Maintain accurate and timely documentation of clinical reviews, determinations, interventions, and care plans.
• Follow applicable federal and state regulations, accreditation standards, organizational policies, and clinical guidelines.
• Support internal and external audits as needed.
• Maintain confidentiality and comply with applicable privacy requirements.

Cross-Functional Collaboration

• Collaborate with pharmacists, pharmacy technicians, nurses, providers, and other internal teams.
• Support implementation of clinical programs and updates to utilization management criteria.
• Communicate clinical recommendations clearly to internal stakeholders and healthcare providers.

Qualifications

· Doctor of Pharmacy (PharmD) required.

· Active, unrestricted pharmacist license in good standing required.

· 3-5 years of pharmacy experience required.

· Prior experience performing pharmacy prior authorization/clinical utilization management reviews required.

· Prior experience developing and managing patient/member care plans required.

· Experience in PBM, managed care, health plan, specialty pharmacy, or ambulatory care preferred.

· Experience with step therapy, quantity limits, specialty medications, and formulary management preferred.

· Experience using pharmacy claims systems, clinical criteria, or utilization management platforms preferred.

Knowledge, Skills, and Abilities

· Strong knowledge of medication therapy and evidence-based clinical guidelines.

· Demonstrated ability to perform prior authorization reviews and make clinically appropriate determinations.

· Demonstrated ability to develop individualized medication-related care plans.

· Ability to interpret clinical information, medical records, and medication histories.

· Strong clinical judgment and attention to detail.

· Excellent written and verbal communication skills.

· Ability to communicate effectively with prescribers, healthcare professionals, and internal teams.

· Strong documentation and organizational skills.

· Ability to manage multiple clinical reviews and priorities in a timely manner.

· Proficiency with electronic medical records, pharmacy systems, and standard Microsoft Office applications.