Clinical Pharmacist

3 days ago

Raleigh, North Carolina, United States Spectraforce Technologies Full time
Clinical Pharmacist 1

Spectraforce Technologies is seeking a highly skilled Clinical Pharmacist to join our team. As a Clinical Pharmacist, you will play a critical role in providing timely drug therapy for Medicaid health plan members by processing prior authorization and medical necessity requests.

Key Responsibilities:
  • Direct resources to individual cases, projects, or critical needs.
  • Update health plan pharmacy documentation in conjunction with state laws.
  • Maintain relationships with health plan pharmacy leadership regarding escalated claims.
  • Implement, maintain, and provide training on 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 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 needed by state or contract.

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