Managed Care Pharmacist HFHP

2 weeks ago

Rockledge, United States Health First Full time

POSITION SUMMARY

HFHP Managed Care Pharmacist. Responsibilities include but are not limited to oversight of the daily pharmacy program operations and the contracted Pharmacy Benefits Manager (PBM).

Ensure achievement of organizational and departmental goals through vigorous monitoring of pharmacy department metrics.

PRIMARY ACCOUNTABILITIES

1. Adhere to all regulatory and certification guidelines including HIPAA, state and Federal Guidelines, and others as communicated through management.

2. Assist the pharmacy program with accreditation processes conducted by external monitoring agencies, such as CMS or NCQA in coordination with Pharmaceutical Services, Medical Management, Integrity, Compliance, and PBM.

3. Participate in P&T committee meetings and in conjunction with internal staff and PBM, make recommendations to committee regarding new medications, formulary placement of medications, and prior authorization criteria (if applicable).

4. Post the HFHP Drug Formulary and prior authorization criteria in coordination with the Pharmacy Services Staff.

5. Review pharmacy prior authorization requests for medical necessity, using best practices and quality standards.

6. Analyze pharmacy claims data for potential Fraud Waste, and Abuse (FWA), compliant claim adjudication, patient safety, and trends in drug cost.

7. Conduct outreach to members and providers on Medication Adherence, Medication Education and Medication Therapy Management

8. Supply accurate, adequate, and timely drug information to the professional staff.

9. Provide training and education to colleagues and staff regarding Managed Care Pharmacy.

10. Participate in community educational programs as needed (e.g., diabetes classes, health fairs).

11. Responsible for regular analysis of pharmacy data, and for maintaining currency with the medical literature to identify quality improvement and cost containment opportunities, in collaboration with staff and leadership.

12. Recommend possible strategies to promote cost-effective therapy and quality of care for HFHP members. Assists members and providers with authorization denials in an effort to help them navigate towards a formulary treatment, or provide advisement with the authorization process.

MINIMUM QUALIFICATIONS

* Education: Doctor of Pharmacy degree from accredited college of pharmacy
* Licensure: License to practice in the state of Florida by Board of Pharmacy
* Certification: None required
* Work Experience: 2 years of experience as a licensed pharmacist in managed care, community pharmacy, hospital or healthcare setting
* Knowledge/Skills/Abilities:

o Knowledge of pharmacy workflow from processing claims to authorizing PA requests, formulary management, and filling prescriptions in any pharmacy practice setting.

o Familiarity with appropriate local, state, and federal pharmacy-related regulations.

o Detail-oriented with advanced analytical and problem solving skills.

o Strong organization, time management and project management skills and multi- tasking abilities.

PREFERRED QUALIFICATIONS

o Education: Master's Degree in a Healthcare or Business-Related Field

o Licensure: No additional required

o Certification: No additional required

o Work Experience: Completion of, or currently enrolled in, residency program (PGY1) in managed care pharmacy, or pharmacy practice

o Knowledge/Skills/Abilities: No additional required

PHYSICAL REQUIREMENTS

o Sedentary - Office Workers

o Sedentary work involves sitting most of the time

o Walking and standing or lifting more than 10 pounds are required only occasionally

o Must be able to tolerate long periods of computer time a day

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