VIVID Clinical Pharmacist

4 weeks ago

Omaha, United States Vivid Clear Rx Full time
Vivid Clear Rx

Job Title: Clinical Pharmacist

Department: Operations

FLSA: Exempt

General Function

The Clinical Pharmacist will be responsible for the maintenance of evidence-based prior authorization criteria and utilization of this information to review and render coverage determinations. This role will also assist with the implementation and operation of clinical programs, formulary management, pipeline monitoring and client relationships and support. Responsibilities to have a heavy focus in specialty pharmacy.

Reporting Relations:

Accountable and Reports to: Senior Healthcare Strategist

Positions that Report to you: None

Primary Duties and Responsibilities:

  • Review and render coverage determinations (prior authorization) or member appeals.
  • Develop and maintain clinical criteria used for coverage determinations
  • Monitor and report on all company-determined metrics related to the prior authorization process and determination rates.
  • Assist with the implementation and management of clinical programs, including programs for data collection and adherence monitoring.
  • Understand plan design parameters available and elected by clients.
  • Provide leadership for onboarding and implementation of new client groups. Collaborate for Quarterly Business Reviews (QBR).
  • Collaborate with teams throughout the organization to assist in responding to RFP's, development of capabilities presentations from a clinical standpoint and evaluate business development opportunities.
  • Provide clinical guidance, support and expertise to various departments.
  • Provide clinical training and ensure consistency throughout the organization on protocols, procedures, policies and disease state management.
  • Build collaborative and supportive relationships with all departments and provide support in understanding compliance and operational guidelines of the organization and/or industry.
  • Maintain confidentiality and adhere to HIPAA requirements.
  • Other duties or special projects may be assigned as necessary.
  • This is an office-based position.
Professional Competencies:
  • Broad understanding of various drug therapeutic categories, and corresponding indications and treatment protocols for major drug categories.
  • Ability to think strategically and develop solutions to complex problems.
  • Experience working in a team-oriented, collaborative environment.
  • Excellent communication, leadership, problem solving, and analytical skills.
  • Strong oral, written, and interpersonal skills; Proficient with MS Excel, Word, and Outlook.
  • Attention to detail with emphasis on organizational skills.
  • Demonstrated ability to meet tight deadlines.
  • Ability to work with all levels of internal management and staff, as well as outside clients and vendors.
Leadership Competencies:
  • Exemplifies company core values, treating others with respect and dignity, with sensitivity to the unique needs of others.
  • Promotes high morale and a positive work environment through professional, constructive relationships.
  • Inspires, encourages, motivates, and energizes the team environment.
  • Establishes and maintains standards of performance.
  • Delegates and defines tasks and responsibilities, giving clear goals in a timely manner.
  • Fosters individual growth and provides constructive and timely feedback by training, coaching, and performance reviews.
  • Communicates, honestly, appropriately, and directly. Openly and willingly listens and receives suggestions from others.
  • Has a clear understanding of human resource policies and applies company's human resource policies in a uniform and consistent manner.
Required Qualifications:
  • Must obtain pharmacist licensure within assigned state.
  • Minimum of five years of pharmacy/clinical experience preferred.
  • Five years post-graduate experience in patient care preferred.
  • Working knowledge of the healthcare industry.
  • HIPAA trained and /or the ability to work with and protect extremely confidential patient and employee information.
  • Ability to travel.
Educational and Experience:

A Bachelor of Science in Pharmacy, Doctorate preferred.

Licensure and Certification Requirements:
  • Registered Pharmacist (RPh)
  • Current unrestricted license in good standing in state of practice.
  • Willingness to obtain company-supported advances certification, education and expertise will be expected upon hire.
Physical Requirements:
  • In an 8 hour day the employee may be asked to lift/carry 20lbs.
  • In an 8 hour day the employee may stand/walk approximately 1 hour.
  • In an 8 hour day the employee sits approximately 7 hours.

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