Clinical Pharmacist 1

Position Title: Clinical Pharmacist 1

Work Location: Remote

Assignment Duration: 3 Months with a potential for extension or conversion

Work Schedule: 9am - 6pm EST , OT possible

Job Description:

* Reviews a completed prior authorization request received from the provider and/or reviews the pharmacy technician's recommended denial, suggested formulary alternatives, comments and attachments for appropriateness.

Develop clinical criteria for medications, recommend plan design changes, and clinical programs to be initiated

* Monitor prior authorization requests

* Provide clinical support to internal departments and address clinical related questions

* Ensure appropriate quality controls and initiates opportunities for performance improvement in pharmacy/practice

* Develop and implement programs designed to impact DUR for both Medicaid and Medicare

* Develop, implement, and maintain policies and procedures for the pharmacy department

* Participate in the coordination of the Medicare MTM program

* Assist case management team with members including clinical rounds presentations

* Verifies member's ID number and date of birth.

* Verifies member's eligibility in the appropriate health plan eligibility system.

* Records carrier and group number if applicable.

* Checks for previous prior authorization decisions.

* Verifies coverage in member's prescription benefit when necessary.

* Verifies coverage in member's health plan benefit when necessary.

* Evaluates prescription claim history.

* Reviews chart notes and/or lab values.

* Identifies provider specialty when appropriate.

* Applies Medical Policy Criteria to prior authorization requests.

* Evaluates whether request meets criteria for approval.

* Reviews the request using professional clinical judgment on a case by case basis. A pharmacist will review medication requests not addressed by P&T Committee criteria or guidelines, develop and draft criteria for the non-formulary medication requested.

* Researches and contributes drug references and clinical information to facilitate prior authorization review: directly to physicians via fax or phone encounter; or to pharmacy technicians via memo or on a personal level as an educational tool

* Communicates with physicians regarding prior authorization