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Hemophilia Clinical Specialist
1 month ago
Prime Therapeutics is seeking a highly skilled Hemophilia Clinical Reviewer to join our team. As a Clinical Reviewer, you will play a critical role in facilitating the development of medical pharmacy solutions programs.
Key Responsibilities:- Support drug utilization review (DUR) efforts by reviewing physician prescribing patterns and consulting with physicians regarding these patterns using evidence-based best practices.
- Work closely with internal staff in the refinement of medical pharmacy management solutions programs.
- Provide consultation on pharmacy issues to clinical operations representatives and facilitate the successful implementation of these programs for customer organizations.
- Discuss with practicing physicians (and other prescribers) to consult on prescribing of specialty medications.
- Coordinate with operations, clinical, medical, reporting, and other internal departments as needed.
Regularly review and monitor prescription claims data and prescribing practices identified as outliers by internal and/or external analysis of pharmacy claims data.
Contacts physicians and prescribers identified as needing consultation to provide coaching on prescribing practices that have been identified as outliers.
Reviews prior authorizations and determines opportunities for interventions.
Tracks contact attempts and contacts per operations procedures. Documents content of and results of consultations as defined in operations procedures; maintains records as required.
Collaborates on the refinement of consultation scripting; solicits and utilizes input from those contacted toward scripting improvements.
Contributes to the success of the operations of the pharmacy program by assisting with the implementation and management of both written and verbal communications to physicians and prescribers and maintenance of the edits and data elements that support the edits.
Is available for consultation on pharmacy-related questions and issues for others within the organization (e.g., health coaches, care managers, etc.).
Updates and maintains program engine, coding, consultation sheets, and outreach program as needed.
Contributes to program improvements by using continuous quality improvement processes, being proactive in identifying improvement opportunities, and contributing ongoing consultation and collaboration with product leaders.
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 providing pharmacy expertise within the organization.