Clinical - Pharmacist 1

2 weeks ago

Raleigh, United States Spectraforce Technologies Full time
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 Clinet'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.

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