Clinical Pharmacist Professional
7 days ago
About Clinical Pharmacists at Lifelancer. Job Title: Clinical Pharmacist Professional. Job Location: Remote, HI, USA Job Type: Full-time Job Seniority Level: This is a clinical professional position on our Medical Management/Health Services team.
Job Summary:
We are seeking an experienced Clinical Pharmacist to join our team in Honolulu, HI. As a Clinical Pharmacist, you will be responsible for providing timely drug therapy for Medicaid health plan members by processing prior authorization and medical necessity requests.
Responsibilities:
• Review prior authorization requests and make determinations for drug products according to member benefits and coverage criteria.
• Set 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.
• Provide clinical guidance and support to the assigned pharmacy technicians.
• Develop and review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design.
• 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.
• Perform other duties as assigned.
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