临床药房评审员（药剂师） - 远程
Clinical Pharmacy Reviewer (Pharmacist) - Remote
临床药房评审员（药剂师）负责评估复杂的预先授权请求、申诉和药物覆盖决定，以确保临床适当性并符合循证指南。作为药事福利管理领域的专家，该职位需解读复杂药物标准、处方集指南、逐步治疗和数量限制，适用于特需药物和非特需药物。通过严格的药物使用审查（DUR）和客观决策，临床药房评审员维护医疗必要性标准，直接影响Dane Street对高质量医疗服务和监管卓越的承诺。
在Dane Street，我们相信卓越的员工体验能带来卓越的客户体验。我们的文化建立在协作、持续改进、责任和关怀之上。
我们关心我们的客户，我们关心我们的员工，我们也互相关心。每位团队成员都在创造一个让每个人感到被尊重、被支持、被赋予权力去成长，并被激励去做有意义工作的环境。
要求
教育/资质：
- 从认证大学获得药学博士（PharmD）学位。
- 在任何美国州持有有效的、无限制的药剂师执照。
必备条件：
· 在PBM环境中至少3年预先授权和/或申诉评审经验。
优先资格：
- 具有Medicare Part D和Medicaid药事福利的经验。
- 了解商业保险药事福利和处方集管理策略。
- 了解逐步治疗要求、数量限制计划和特需药物。
- 深入了解药物使用审查（DUR）。
- 能够解读和应用复杂的临床指南。
- 福利
- 为什么加入Dane Street？
- 协作的远程文化
- 职业发展机会
- 支持医疗行业的有意义工作
- 全面的福利
- 自2021年起获得“最佳工作场所”认证
- 对员工发展的承诺
- 居家办公技术要求：
- 自备并支持自己的互联网服务。
- 保持不间断的互联网连接是所有居家办公职位的要求。
- 平等机会声明：
- 在Dane Street，关爱他人是我们所做一切的核心。我们致力于打造一个包容的工作环境，让每位员工都感到被尊重、被重视，并被赋予权力做出贡献。我们积极促进多元化和包容性。
查看英文原文
The Clinical Pharmacy Reviewer (Pharmacist) evaluates complex prior authorization requests, appeals, and medication coverage determinations to ensure clinical appropriateness and compliance with evidence-based guidelines. Acting as a subject matter expert in pharmacy benefit management, this role interprets complex drug criteria, formulary guidelines, step therapy, and quantity limits for specialty and non-specialty medications. Through rigorous Drug Utilization Review (DUR) and objective decision-making, the Clinical Pharmacy Reviewer upholds medical necessity standards, directly impacting Dane Street's commitment to high-quality healthcare delivery and regulatory excellence.
At Dane Street, we believe exceptional employee experiences create exceptional client experiences. Our culture is built on collaboration, continuous improvement, accountability, and care.
We care for our customers, we care for our employees, and we care for one another. Every team member plays an important role in creating an environment where people feel respected, supported, empowered to grow, and inspired to do meaningful work.
Requirements
EDUCATION/CREDENTIALS:
- Doctor of Pharmacy (PharmD) degree from an accredited university.
- Active, unencumbered pharmacist license in any U.S. State.
Must Haves:
· Minimum of 3 years of Prior Authorization and/or Appeals review experience within a PBM environment.
Preferred Qualifications:
- Experience with Medicare Part D and Medicaid pharmacy benefits.
- Knowledge of commercial insurance pharmacy benefits and formulary management strategies.
- Knowledge of step therapy requirements, quantity limit programs, and specialty medications.
- In-depth knowledge of Drug Utilization Review (DUR).
- Demonstrated ability to interpret and apply complex clinical guidelines.
Benefits
Why Join Dane Street?
- Collaborative remote culture
- Professional growth opportunities
- Meaningful work supporting the healthcare industry
- Comprehensive benefits
- Great Place to Work Certified since 2021
- Commitment to employee development
WORK FROM HOME TECHNICAL REQUIREMENTS:
Supply and support their own internet services.
Maintaining an uninterrupted internet connection is a requirement of all work-from-home positions.
Equal Opportunity Statement:
At Dane Street, caring for people is at the heart of what we do. We are committed to creating an inclusive workplace where every employee feels respected, valued, and empowered to contribute. We provide equal employment opportunities to all applicants and employees and make employment decisions based on qualifications, merit, business needs, and without regard to race, color, religion, sexual orientation, gender identity or expression, national origin, age, disability, veteran status, or any other characteristic protected by applicable federal, state, or local law.
Originally posted on Himalayas