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Clinical - Pharmacist 1

3 months ago

Tampa, United States Axelon Full time

Location: Fully Remote

Shift: 8am - 5pm EST , No OT

Job Description: Summary: The main function of a pharmacist is to dispense prescription medications to patients and offer expertise in the safe use of prescriptions. They also may conduct health and wellness screenings, provide immunizations, oversee the medications given to patients, and provide advice on healthy lifestyles.

Job Description is as follows:
• Reviews a completed prior authorization request received from the provider and/or reviews the pharmacy technician's recommended denial, suggested formulary alternatives, comments and attachments for appropriateness.
• Verifies member's ID number and date of birth.
• Verifies member's eligibility in the appropriate health plan eligibility system.
• Records carrier and group number if applicable.
• Checks for previous prior authorization decisions.
• Verifies coverage in member's prescription benefit when necessary.
• Verifies coverage in member's health plan benefit when necessary.
• Evaluates prescription claim history.
• Reviews chart notes and/or lab values.
• Identifies provider specialty when appropriate.
• Applies Medical Policy Criteria to prior authorization requests.
• Evaluates whether request meets criteria for approval.
• Reviews the request using professional clinical judgment on a case by case basis. A pharmacist will review medication requests not addressed by P&T Committee criteria or guidelines, develop and draft criteria for the non-formulary medication requested.
• Researches and contributes drug references and clinical information to facilitate prior authorization review: directly to physicians via fax or phone encounter; or to pharmacy technicians via memo or on a personal level as an educational tool
• Communicates with physicians regarding prior authorization:
o For a non-formulary drug
o Plan benefits, exclusions
o Quantity limits
o Age restrictions
o Formulary alternatives
• Retrieves and collects data through available reporting resources (i.e. Discoverer, IT Department)
• Compiles data for reporting purposes:
o Drug utilization of non-formulary drugs
o Overturned IPS recommended denials
o Audit pharmacy claims greater than $200.00
o Suggest addition or deletion of drugs to/from the formulary
o Updating qty/days or age limit ends
o Support National P&T Committee
o Other tasks which may arise during the performance of any of the above mentioned duties.

Walk me through the day to day responsibilities of this the role and a description of the project:

  • Included in job description I submitted in Work Day
Describe the performance expectations/metrics for this individual and their team:
  • Sign 85 - 100 cases daily
Internal/External Groups with which the Candidate will interface: Required Skills/Experience: Preferred Skills/ Experience: 1. Pharmacy Experience (any setting) 1. 2. 2. 3. 3. Education Requirement: Pharm D Education Preferred: Software Skills Required: Office Suite Required Certifications: n/ Required Testing: n/ Comments for Vendors: