Pharmacist II

1 week ago

Carson City, United States Reliable Health Care Services of Southern Nevada, Inc Full time
Reliable Health Care is hiring a Pharmacist II for The Nevada Division of Health Care Financing and Policy (DHCFP) located in Carson City, NV

DHCFP is seeking a Medicaid Contract Pharmacist to provide clinical expertise within the Nevada Medicaid pharmacy benefit. This is a full-time, contract position that may require travel to/within the state of Nevada.

The mission of DHCFP is to purchase and provide quality health care services to low-income Nevadans in the most efficient manner; promote equal access to health care at an affordable cost to the taxpayers of Nevada; restrain the growth of health care costs; and review Medicaid and other state health care programs to maximize potential federal revenue.

Highly Competitive Salary - up to $74/hour
Regular work hours with flex schedule options
Hybrid - in-office (Carson City or Reno) and remote

Benefits:

W2 position
Flexible schedule
Highly competitive salary
Health, Dental, and Vision available for full-time employees
PTO (with annual increases)
CEU/Professional Development reimbursements
No-cost professional liability insurance

THE POSITION: This position is within the DHCFP, commonly known as Nevada Medicaid. This position reports directly to, and serves at the pleasure of, the Medicaid Pharmacy Director.

The Medicaid Contract Pharmacist will perform clinical reviews of medical and outpatient pharmacy utilization management criteria and cases using their clinical acumen and taking into consideration program policies and state and federal regulations. They will assist with drug prior authorization (PA) exception requests, appeals reviews, develop policies based upon clinical guidelines, and conduct audits of the pharmacy benefit across Fee-for-Service and Managed Care Organizations (MCO). The Medicaid Contract Pharmacist will be required to testify at applicable appeals hearings, evaluate offsetting costs and advise on rebate program changes, assist in the administration of the pharmacy benefit, and utilize shifts in utilization to recommend changes to benefit design.

Other duties the Medicaid Contract Pharmacist is responsible for:

Formulary management including but not limited to activities such as development of clinical pharmacy utilization management criteria, cost decision-making, and benefit determination.
Participate in the development and execution of clinical quality assurance programs.
Provide clinical guidance and support to various internal departments that require clinical pharmacist intervention.
Assist with the development of cost-effective pharmacy measures, provide delegate oversight of all Nevada Medicaid Pharmacy Benefits Managers (PBM), and advise on claims issues.
Assist with developing and presenting drug monographs, executive summaries, therapeutic class reviews, and medication policies to Pharmacy & Therapeutics Committees (DUR and SSSB boards).
Utilize claims data and trends to evaluate benefit design for inappropriate utilization and opportunities to improve outcomes and optimize drug spend.
Provide oversight of the administration of the Preferred Drug List (PDL) and evaluate utilization shifts and associated impact on prescription drug spending.
Perform other oversight activities as assigned by the Medicaid Pharmacy Director.

QUALIFICATIONS:

Doctor of Pharmacy (PharmD) degree or equivalent education that satisfies pharmacist license requirements
Current, valid Pharmacist license to practice in any state in good standing
Two or more years of clinical, managed care, health plan, or pharmacy benefit management experience
Proficient in the evaluation of drug literature, clinical trial data, and electronic database information
Strong clinical and analytical background for specialty medication is preferred
Since 1991, Reliable Health Care Services has been supplying the private sector and government with highly qualified medical personnel. We are Certified by The Joint Commission and have amazing opportunities for placement at premier healthcare programs, medical facilities, and hospitals.

Recruiter: Michelle

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