Clinical Pharmacist

Piper Companies is seeking a Clinical Pharmacist to join a leading healthcare insurance and pharmacy services organization for an remote contract opportunity based in North Carolina. The Clinical Pharmacist will support pharmacy utilization management activities, evaluate medication coverage requests, and provide clinical expertise to ensure appropriate benefit determinations for members while maintaining compliance with regulatory and organizational standards.

Responsibilities for the Clinical Pharmacist include:

·      Evaluate prior authorization and coverage review requests by applying clinical guidelines, plan benefits, and formulary requirements to determine medication eligibility.

·      Monitor utilization management activities, analyze pharmacy review metrics, and prepare reports supporting compliance and operational objectives.

·      Serve as a clinical resource for pharmacy technicians by providing guidance on pharmacy benefit policies, drug therapies, and review processes.

·      Conduct research on medications, treatment protocols, and disease state management to support coverage decisions and formulary initiatives.

·      Identify opportunities for quality improvement within pharmacy operations and assist with implementing process enhancements to improve accuracy and efficiency.

Qualifications for the Clinical Pharmacist include:

·      Active North Carolina Pharmacist license and current residence within North Carolina.

·      Minimum of 3 years of pharmacist experience with a background in retail pharmacy and Medicare Part D programs.

·      Previous telephonic experience working for a Health Insurance Company, Managed Care Organization, or Pharmacy Benefit Management environment.

·      Strong knowledge of pharmacy claims adjudication, NCPDP systems, and drug coding classifications including NDC, GCN, GPI, and related standards.

·      Bachelor's degree in Pharmacy, PharmD, or advanced healthcare-related degree with demonstrated stability and long-term success in contract-based roles.

Compensation for the Clinical Pharmacist:

·      Hourly Rate: $50-$60

·      Comprehensive Benefits: Medical, Dental, Vision, 401(k), Sick Leave (as required by law), and Paid Holidays

This job opens for applications on 7/31/26. Applications for this job will be accepted for at least 30 days from the posting date.

Keywords: clinical pharmacist, managed care, health insurance, Medicare Part D, prior authorization, utilization management, pharmacy benefits, formulary review, pharmacy operations, medication therapy management, drug information, claims, NCPDP, NDC, GPI, GCN, compliance, quality assurance, coverage determination, retail pharmacy, healthcare payer, PBM, utilization review, clinical decision making, disease state management, pharmacy technician support, medication authorization, healthcare operations, pharmacy services, onsite pharmacist.

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