Clinical Pharmacist (Managed Care)
Posted on Aug 12, 2019 by Rx relief
Join one of the nation's leading pharmacist placement firms! Right now, Rx relief has a great opportunity for an experienced Clinical Pharmacist (Managed Care). Voted Best of Staffing by both clients and talent, we are a specialty staffing company providing supplemental pharmacy professionals for all pharmacy practice settings. We have an opening for a Clinical Pharmacist (Managed Care) in the Sacramento, CA area. As a member of our team, you'll enjoy a customized approach to your career needs as well as comprehensive benefits! Join our dynamic team, apply today!
Clinical Pharmacist (Managed Care)
As a Managed Care Pharmacist, you will be responsible for maintaining productivity and quality standards as well as legal and company compliance and track coverage determination requests for approvals.
- Responsible for support and input to clinical programs such as: Health Management, Drug Utilization Review, Formulary development, and Prior Authorization programs to encourage appropriate, high quality, cost effective drug therapy; and to identify opportunities for improvement in efficiency, accuracy, and appropriateness of the programs in place.
- Participate in the Coverage Determination (Certification, Prior Authorization, Medical Exception, Exception to Coverage, etc.) process be reviewing all requests which are not clearly approvable based on specified criteria (algorithms), making all coverage denial determinations, and identifying themselves by first name, title, and responsibility in relation to drug utilization management program administration
- Continually monitor the quality and efficiency of the Coverage Determination process including coverage criteria, denial language, and communication with prescribers.
- Provide input to clinical content of new programs and for maintenance of existing programs.
- Complete all annual URAC training requirements
- Responsible for participating in core teams working on new program/ product development.
- Facilitation of communication and education to clients, members, and internal staff regarding clinical daily issues and objectives.
- Provide support to operational departments on the implementation of various PBM programs and daily functioning in support of member/patient quality of care.
- Responsible for supporting / providing clinical expertise related to formulary decisions made by the Pharmacy and Therapeutics committee.
- May review health care survey data for Medicare Part D qualified participants and/or perform phone consultations with Med-D enrollees; aid in documentation of calls; designate enrollees for repeat interaction.
- Assists Customer Care, Client Services and other internal customers in responding to and resolving pharmacy-related inquiries from members, clients, providers, or pharmacies.
- Maintain open lines of communication with other functional areas/departments
- Participate in multi-departmental meetings and committees to accomplish projects
- Responsible for staying current with clinical literature and guidelines, and relaying those to the program development core teams
- Review specialty medication prior authorization requests (i.e. biopharmaceuticals) according to established treatment protocols, clinical criteria and member benefits.
- Make coverage determinations within the defined turnaround times and meet regulatory requirements
- Responsible for clinical criteria for specialty medications including analysis, monitoring of industry trends and develop criteria recommendations for Pharmacy and Therapeutics Committee and clients
- Define and coordinate prior authorization and drug utilization reviews reports for clients and ensure regulatory reporting requirements for drug utilization review, fraud and abuse reporting are met
- Oversee the drug utilization review and medication therapy management programs for specialty medications at the assigned plan to meet regulatory requirements and develop systematic reviews of prescription claims to meet strategic initiatives
- Develop and design specialty medication clinical edits for claims adjudication and enhanced drug utilization review
- Provide clinical guidance, support and oversight 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 practice specific to specialty pharmacy
- Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
Do you have recent Clinical Pharmacist (Managed Care) experience? If so, this is the position for you! Apply Today!
Specific Clinical Pharmacist (Managed Care) requirements:
- Area: Must be able to work in the Sacramento, CA area.
- Licensure Requirements: Active California Pharmacist license.
- Education: Bachelor's or Doctor of Pharmacy degree.
- Years of Experience: Minimum one-year pharmacy residency training in Managed Care completed recommended. Two to four years of experience or equivalent training working within a pharmacy setting.
- Schedule: Monday to Friday, between hours of 7 am - 6 pm
- Length of Assignment: Temporary or Temporary to Hire
- Pay: Depending on Experience
- Background/ Drug Requirements: Ability to successfully pass background check and drug screen.
At Rx relief, we are proud to offer the following benefits:
- Health Insurance with Prescription coverage
- 401(k) and deferred compensation programs
- Cafeteria Plans
- Free CE
- Low-cost group health benefits for Part-Time Associates