Clinical Services Pharmacist

3 weeks ago


Providence, Rhode Island, United States ConsultNet Full time

Clinical Services Pharmacist Role

The Clinical Services Pharmacist will be responsible for the execution of clinical services in support of our clients' Rx initiatives. This includes ensuring that members receive timely overrides and that all plans process correctly. The ideal candidate will have a working knowledge of managed care pharmacy services and Coverage Determination workflows, as well as a thorough understanding of Medicare Part D regulations.

Key Responsibilities:

  • Prior authorizations, formulary maintenance, drug utilization review, and building and maintaining drug rules for various Commercial and Medicare Part D clients.
  • Gathering and building drug rule specific information for implementations, coordination, and research of drug information for new clinical programs and initiatives.
  • Drug use evaluation and assisting Call Center staff in situations where clinical input is needed.
  • Providing clinical information to Commercial and Med D clients as appropriate, and executing clinical initiative programs as assigned.

Requirements:

  • Working knowledge of managed care pharmacy services and Coverage Determination workflows.
  • Thorough understanding of Medicare Part D regulations.
  • Previous experience in clinical information coordination and excellent writing skills.

Education and Experience:

  • Bachelor of Science Degree in Pharmacy or PharmD.
  • Minimum of 2 years of experience working as a retail pharmacist preferred.
  • 3 years of experience in the Clinical Services Department of a PBM.

Certificates, Licenses, Registrations:

  • RPh or PharmD Credential.


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