Medicare Part D Pharmacy Resident

4 weeks ago


Lansing, Michigan, United States Emergent Holdings Full time
Job Summary

The Medicare Part D Pharmacy Resident program is designed to empower and educate residents in all aspects of Medicare Part D practice. This includes formulary management, pharmacy and regulatory compliance, pharmacy benefits management, clinical pharmacy programs, plan performance and quality assurance, Medicare Part B and D prior authorizations and appeals, product development, administration, and leadership.

Responsibilities
  1. Assist senior leadership in planning, developing, and implementing Medicare Part D products, programs, and services, including submission of the CMS bid.
  2. Develop, implement, and maintain utilization management and drug utilization review programs.
  3. Provide clinical support for processing drug information inquiries.
  4. Participate in the Pharmacy & Therapeutics committee, making clinical and financial formulary recommendations.
  5. Develop, implement, and update physician and patient educational materials.
  6. Work with internal departments to develop sound clinical programs and monitor their effectiveness and cost savings.
  7. Promote appropriate prescribing behavior among BCBSM participating physicians for the Medicare Part D population.
  8. Propose, plan, execute, and review quality assurance activities related to medication reconciliation, academic detailing, and controlled substance clinical reviews.
  9. Assist with oversight of the Part D Medication Therapy Management program, including vendor management and MTM program submission to CMS.
  10. Prepare, review, and conduct presentations and continuing education programs for various audiences.
  11. Assist with internal and CMS audits, and other Part D operational areas, such as transition monitoring and 1/1 readiness.
  12. Participate in the review of prior authorizations for drugs covered under Medicare Part D and Part B.
  13. Participate in the development and execution of initiatives to improve the Medicare Stars quality measures, focusing on medication adherence programs.
  14. Complete a pharmacy research project, including a poster presentation.
  15. Collaborate with the formulary team to help with the drug rebate program, formulary development, and the Coverage Determinations, Appeals, and Grievance process.
  16. Assist with the Part D component of Requests for Proposals from prospective client groups.
  17. Identify opportunities for improvement in clinical programs based on data analysis.
  18. Aid in the management of high-cost specialty medications.
  19. Actively participate in the education of pharmacy students, both as a lecturer and by precepting pharmacy interns and students on rotation.
Requirements

To be considered for this position, candidates must have a Doctor of Pharmacy degree, a PharmD program GPA of at least 3.0, and a current Michigan Pharmacist License within 90 days of start. Managed care pharmacy work or internship experience is strongly preferred. Candidates must also be proficient in Microsoft Office and have excellent communication and leadership skills.

Work Environment

This position is performed in an office setting with no unusual hazards.

Pay Range

The actual compensation decision will consider internal equity, candidate skills and experience, geographic location, market, and other factors. A reasonable estimate for this role is between $46,100 and $77,200.



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