Clinical Pharmacist

4 weeks ago

Englewood, Colorado, United States ResCare Full time
Job Summary

The Margin Clinical Pharmacist will provide recommendations for drug therapy and contribute to the optimal medication management of patients. This role will work with the Margin team to determine appropriate drug therapy, make recommendations for medical billing or PBM billing, and review insurance-based formulary. The pharmacist will also interpret, clarify, verify, and request updated orders for medications and other pharmaceutical supplies pursuant to a medication order.

Responsibilities

* Evaluates physician medication orders for appropriateness of drug, margin, medical or pharmacy billing, dosage, potential interactions, and route of administration
* Provides support for the Infusion pharmacy dispensing and fulfillment operations across the pharmacy network
* Engages in business improvement and sustainability, cost reduction projects and process flow optimization
* Makes recommendations for therapy changes to the physician and facility staff as appropriate
* Continuous review of products selected for each patient to validate margin, formulary changes, and medication appropriateness based on disease state
* Makes decisions to approve or deny each claim that is reviewed accurately
* Audits previous approvals to ensure losses are appropriate and the reimbursement is up to date
* Identifies brand to generic conversion opportunities to enhance probability and minimize copay costs to patients
* Serves as lead resource to internal stakeholders for medical/drug information inquiries
* Identifies problem areas with effective follow-through to quickly address the root causes and coordinate activities with cross functional team members from Operations, IT, Finance and Procurement/Corporate Inventory
* Maintains patient database to include appropriate current and past medical history, appropriate clinical and laboratory data, and concurrent medication (including over-the-counter and home remedies)
* Collaborates with the healthcare team to provide clinical and technical support as needed
* Documents all communication with physicians, nurses, other members of the healthcare team and patients/residents and their family members in the medical record
* Responds to patient-specific or non-patient-specific inquiries from internal or external stakeholders for drug/medical information related to any medication within company's business portfolio
* Assists facility/agency staff personnel with procedures relating to safe and effective methods of procuring, maintaining, administering and disposing of drugs

Qualifications

* Bachelor's Degree in Pharmacy or PharmD
* Master's degree in accounting or finance preferred

This role is a great opportunity to work with a leading provider of Specialty Infusion services and contribute to the optimal medication management of patients.

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