Date: Oct 30, 2024
Location:
Any city, NJ, US, 99999
Req ID: 27507
Summary
Facilitates efforts in the development of clinical pharmacy solutions programs including PA criteria development and coordination of Pharmacy and Therapeutic Committee (PT) and DUR Board meetings.
Supports Prospective and Retrospective drug utilization review (DUR) efforts by reviewing physician prescribing patterns, consulting with physicians regarding these patterns using evidence-based best practices, working closely with internal staff in the refinement of the pharmacy management solutions programs, and facilitating the successful implementation of these programs.
Coordinates with operations, clinical, medical, reporting, and other internal departments as needed.
Your role in our mission
• Reviews utilization and trending observed in POS claim history.
• Evaluates drug and drug class reviews based on sound evidence-based research and processes widely accepted by the medical profession. Using appropriate methods that support the principles of high-quality evidence-based medicine.
• Develops clinical PA criteria protocol recommendations and documents to present to NJ DUR Board.
• Coordinates NJ DURB meetings, prepares agenda, schedules with the DURB members, chairs the meeting, and acts as secretary for meeting minutes, and documents action items.
• Provides follow up required to gain consents from state commissioners on new protocols after DURB approval.
• Reviews correspondences from prescribers and reaches out to prescribers to resolve problem claims when necessary.
• Resolves clinical questions that arise from the Staff, State and MCOs.
• Contacts client’s pharmacy chief and/or medical director when necessary to seek guidance in problem claims.
• Prepares and educates Gainwell pharmacy staff on DURB reviewed/recommended protocols or any other subject of interest.
• Prepares medical necessity forms (MNFs) corresponding to new protocols prior to implementation.
• Performs prospective and retrospective drug utilization reviews for State beneficiaries.
• Participates in programing meetings for implementation of approved protocols.
• Prepares a weekly NDC price changes report.
• Participates in MCO quarterly meetings with the State staff.
• Represents the State at fair hearings when requested by client.
• Completes the DUR section of the annual CMS report and meets with state staff to review completed report prior to submission.
• Joins the State clinical staff for meetings with medical representatives during new drug presentations or current drug reviews.
• Regularly reviews and monitors prescription claims data and prescribing practices identified as outliers by internal and/or external analysis of pharmacy claims data to develop relevant Retrospective DUR initiatives. Presents initiatives to the DUR Board including methods, interventions, communication, and outcomes.
• Contacts physicians and prescribers identified as needing consultation to provide coaching on prescribing practices that have been identified as outliers. Reviews prior authorization reports and determines opportunities for interventions.
• Tracks contact attempts and contacts per operations procedures. Documents content of and results of consultations as defined in operations procedures; maintains records as required.
• Collaborates on the refinement of consultation scripting; solicits and utilizes input from those contacted toward scripting improvements.
• Contributes to program improvements by using continuous quality improvement processes, by being proactive in identifying improvement opportunities and by contributing ongoing consultation and collaboration with product leaders.
• Upholds clinical integrity of pharmaceutical solutions by staying up to date on medication information, contributing to the identification of pharmacy program best practices, collaborating with Medical Directors, Medical Dept, and Clinical Dept and providing pharmacy expertise within the organization.
What we're looking for
• Management experience in the coordination of and collaboration of work teams preferred.
• 5 years' experience in clinical pharmacy.
• Experience developing prior authorization criteria and presenting to PT committee or DUR Boards.
• Ability to perform clinical reviews using relevant compendia and clinical trial data.
• Analytical skills which can translate into practical and pragmatic recommendations.
• Strong team orientation with respect for all members.
• Strong verbal and written communications skills.
• People skills are essential that allow for the successful consultation with physicians, prescribers, and pharmacists and for successful collaboration with company employees and the state client.
• Must be comfortable with using computers and the internet; basic skills with Microsoft office products and ability to quickly learn proprietary systems.
Education: PharmD (Required)
License and Certifications: Licensed pharmacist, NJ State Pharmacy License preferred.
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