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Pharmacist - Health Plan Specialist
2 months ago
About this Role
As a Pharmacist, you play a vital role in promoting safe, effective, and cost-efficient medication use while supporting the overall goals of the health plan in improving member health outcomes.
Key Responsibilities
- Conduct activities to ensure safe and cost-effective medication use, including monitoring medication patterns, identifying potential misuse or overuse, and implementing interventions as needed.
- Participate in quality improvement initiatives aimed at enhancing medication-related outcomes, such as medication adherence and safety.
- Educate healthcare providers within the network about the health plan's formulary, coverage policies, and medication-related initiatives to ensure alignment with best practices and optimize patient care.
- Review medication requests that require prior authorization to ensure they meet clinical criteria for coverage, assessing the appropriateness of the medication based on medical guidelines and making coverage decisions accordingly.
- Develop and manage the formulary, which is the list of medications covered by the health plan.
Required Qualifications
- Active Registered Pharmacist License
- 2 years of experience as a Pharmacist
- 1 year within a Managed Care setting