Title: Clinical - Pharmacist 1
Duration: 12 months
Location: Remote
Position Purpose
- Provide timely drug therapy for Medicaid health plan members by processing prior authorization and medical necessity requests.
- Direct resources to individual cases, projects, or critical needs.
- Update health plan pharmacy documentation in conjunction with state laws.
- Maintain relationships with all Client's health plan pharmacy leadership regarding escalated claims.
- Implement, maintain and provide training on all departmental process and procedural documents, including prior authorizations.
- Manage prior authorization requests and pharmacists' determinations for drug products according to member benefits and coverage criteria.
- Provide clinical guidance and support to the assigned pharmacists and pharmacy technicians.
- Responsible for setting criteria for medication analysis, coordinate reports to clients, meet regulatory reporting requirements for drug utilization review and fraud and abuse reporting.
- Develop clinical criteria for review of non-formulary or non-preferred drug lists medications and communicate recommendations to clients.
- Oversee the drug utilization review and medication therapy management programs at the assigned plan to meet Medicare Part D requirements and develop systematic reviews of prescription claims to meet strategic initiatives.
- 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.
Qualifications
Education/Experience
Bachelor's degree or advanced degree (PharmD., M.S) in pharmacy. 3+ years of retail or hospital pharmacy experience or 1+ years of managed care pharmacy experience. Clinical pharmacy experience in managed healthcare preferred.
License/Certification:
Current state's Pharmacist license with no restrictions. Additional license may be required as need by state or contract.
#J-18808-Ljbffr
