Clinical Pharmacist

Blue Cross NC

. Provide timely drug therapy for health plan members by reviewing and processing prior authorization requests using clinical judgment and medical policy .

Posted 10/5/2026full-timeRemote • North Carolina • United StatesMid-LevelSenior💰 $118,691 - $189,906 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in drug therapy management, including prior authorization processes, clinical judgment, and adherence to pharmacy regulations. Proficient in evaluating quality controls and implementing performance improvements within pharmacy practices.

Highest-signal resume keywords

Pharmacy LicensePrior Authorization ReviewDrug Coding KnowledgeClinical JudgmentQuality Control Implementation

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Drug CodingClinical JudgmentPrior Authorization ProcessingUtilization ReviewPharmacy Practices KnowledgeMedication ManagementMedication SafetyPerformance ImprovementGuideline Criteria ReviewDisease State Understanding

Tools & Technologies

NCPDP Claims Adjudication Systems

Certifications & Qualifications

Bachelor's DegreeCurrent Pharmacy License

Industry Keywords

Drug TherapyPharmacy RegulationPharmacy Benefit DesignPharmacy and Therapeutics CommitteeCompliance Tracking

About the role

Key responsibilities & impact

Provide timely drug therapy for health plan members by reviewing and processing prior authorization requests using clinical judgment and medical policy
Review prior authorization requests and make determinations for drug products according to member benefits and coverage criteria
Report utilization review statistics to corporate compliance committees
Review data and summarize daily utilization review numbers
Track compliance of review cases
Provide clinical guidance and support to assigned pharmacy technicians
Review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design
Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices
Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews

Requirements

What you’ll need

Bachelor's degree or advanced degree
3+ years of experience in related field
Current states pharmacy license
Knowledge of drug coding (NDC, GCN, GPI and USC)
Knowledge of NCPDP claims adjudication systems
Knowledge of guideline criteria for prior authorization and non-formulary drugs
Clinical judgment and medical policy knowledge
Drug knowledge and disease state understanding
Knowledge of pharmacy practices, quality controls, and performance improvement
Knowledge of pharmacy regulation, medication management, medication safety, and related pharmacy operations

Benefits

Comp & perks

Annual Incentive Bonus based on annual corporate goal achievement and individual performance
401(k) with employer match
Paid Time Off (PTO)
Competitive health benefits
Wellness programs
Robust Total Rewards package