Clinical Pharmacy Reviewer

Job Title: Clinical Pharmacy Reviewer

WHAT IS NEXT IN YOUR CAREER IN 2023?

Are you looking for a position with tremendous growth potential?

Gallagher Bassett, a premier multiline worldwide claims services provider, is looking for Licensed Philippine Nurses or Pharmacists to be part of their team at their first Philippine-based site. The role will provide support to the Pharmacy Benefit Manager in terms of processing incoming medication alerts, evaluating prescription history, evaluating all prescribed medication to identify adverse drug interactions, and interacting with claims administrators, PBMs, and prescribing physicians.

Job Responsibilities:

• Nurses/Pharmacists will process incoming medication alerts received by the Pharmacy Benefit Manager.
• Nurses/Pharmacists will evaluate prescription history, current clinical information and pertinent claim details to determine if the prescribed medication is medically appropriate based on Evidence-based Guidelines.
• Nurses/Pharmacists will need to evaluate all prescribed medications to identify possible adverse drug interactions and, Daily Morphine Equivalent Dosage when opioids are prescribed. Current clinical information will also need to be evaluated for any clinical contraindications to prescribed medications.
• Nurses/Pharmacists will need to enter clinical recommendations in the PBM medication portal once the review is completed.
• Nurses/Pharmacists will need to interact with claims administrators, PBMs and prescribing physicians as needed.

• Other duties assigned to PH RNs; potential to assist other LOBs for local RNs as required by the business.



Qualifications:

• An active Nursing or Pharmacy license in the Philippines
• Prior experience in US Healthcare Insurance
• Preferably with Workers Compensation and/or UR/UM background
• Familiarity with Pharmacy Benefit Management is a plus
• Ability to review medical records, prescriptions, and patient histories
• Skilled in creating clinical summaries
• Must possess good written and oral communications skills
• Organized with excellent decision-making and time-management skills
• Typing speed of >45 words per minute is preferred.
• Ability to multitask in a fast-paced environment
• Proficient in MS Outlook, Word and Excel with general computer literacy 

Compensation Package: up to 55,000