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NJ DUR Clinical Pharmacist

3 months ago

Jersey City, United States Gainwell Technologies Full time
Summary

Facilitates efforts in the development of clinical pharmacy solutions programs including PA criteria development and coordination of Pharmacy and Therapeutic Committee (P&T) 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.
• Evaluate 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.
• Develop clinical PA criteria protocol recommendations and documents to present to NJ DUR Board.
• Coordinate NJ DURB meetings, prepare agenda, chair the meeting, and act as secretary for meeting minutes, action items, and any follow up required.
• 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.
• Contact client's pharmacy chief and/or medical director when necessary to seek guidance in problem claims.
• Prepare and educate Gainwell pharmacy staff on DURB reviewed/recommended protocols. Or any other subject of interest.
• Prepare medical necessity forms (MNFs) corresponding to new protocols prior to implementation.
• Performs prospective and retrospective drug utilization reviews for State beneficiaries.
• Participate in programing meetings for implementation of approved protocols.
• Prepare a weekly NDC price changes report.
• Participate in MCO quarterly meetings with the State staff.
• Represent the State at fair hearings when requested by client.
• Complete the DUR section of the annual CMS report and meet with state staff to review completed report prior to submission.
• Handles inbound call volume from pharmacy providers and prescribers and documents all calls accurately.
• Join the State clinical staff for meetings with medical representatives during new drugs presentations or current drugs review.
• 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. Present 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 determine opportunities for interventions.
• 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 provides 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
• 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 external vendors who do not directly report to this job.
• Must be comfortable with using computers and the internet; basic skills with Microsoft office products and ability to quickly learn proprietary systems.

NJ State Licensure required