Clinical Pharmacy Reviewer, Pharmacist

🔥 0 minutes ago

🇺🇸 United States – Remote

⏳ Contract/Temporary

🟡 Mid-level

🟠 Senior

💊 Pharmacist

👻 Ghost score 25%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Dane Street

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

💼 Consulting

⚖️ Legal

Healthcare • Consulting • Legal

Dane Street is a national leader in Independent Medical Exams and Reviews, providing objective, compliant, and timely Independent Medical Examinations, Peer Reviews, and other medical reports. With a large network of over 16,000 physicians, the company offers its services across 25,000 locations and 100 specialties, including Workers' Compensation, Auto, Liability, and Disability claims. Dane Street supports Insurance Carriers, Third Party Administrators, Managed Care Organizations, and Federal/State entities with expert medical analyses, helping them make accurate determinations. The company is recognized for its quality, fast turnaround times, and efficient processes, earning accolades like the NCQA Accreditation in Utilization Management and the Great Place to Work certification.

📋 Description

• Evaluate complex prior authorization requests, appeals, and medication coverage determinations • Ensure clinical appropriateness and compliance with evidence-based guidelines • Act as a subject matter expert in pharmacy benefit management • Interpret complex drug criteria, formulary guidelines, step therapy, and quantity limits for specialty and non-specialty medications • Conduct rigorous Drug Utilization Review (DUR) • Make objective decisions supporting medical necessity standards • Contribute to high-quality healthcare delivery and regulatory excellence

🎯 Requirements

• Doctor of Pharmacy (PharmD) degree from an accredited university • Active, unencumbered pharmacist license in any U.S. State • Minimum of 3 years of Prior Authorization and/or Appeals review experience within a PBM environment • 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

• 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 • Employer-provided? No: candidates must supply and support their own internet services • Uninterrupted internet connection for work-from-home employment