Medicare D Senior Clinical Pharmacist

Arizona, Rhode Island

Job Description

Serves as client or subject matter expert for an assigned client and/or program. Performs prospective and/or retrospective drug utilization reviews and appeals review per State and Federal regulations. Coordinates the distribution of clinical drug information as well as educate staff on the use of pharmaceutical treatment regimens and criteria. Serves as a training resource, mentor, subject matter expert and coach to clinical pharmacy technicians, and other clinical staff. Complies with all corporate and facility standard operating procedures, policies, guidelines, and work instructions.

Essential Functions


- Prior-authorization liaison to the client and to the account management team. Advises and assists with clinical edit implementation, participates in appeals determination at the client level. Measures and reports on required contractual requirements. May assist with client and internal reports for data validation and research escalated issues.
- Collaborates with clinical account manager and other personnel in developing treatment guidelines and program enhancements. May participate in plan formulary development and criteria management as required by the client. Supports the Pharmacy and Therapeutics Committee. Validates the clinical availability of multisource products for provider utilization. Coordinates clinical activities for new implementations.
- Assesses, investigates and resolves escalated issues to achieve client satisfaction, which may include Peer to Peer reviews, denial, and appeal processes. Ensures timely and accurate delivery of reports to clients and management.
- Provides clinical and operational support to staff pharmacists. Serves as the client-specfiic technical on-site resource. Assists with training for new clinical staff. Conveys clinical updates to team as required. Assesses training needs within team. Serves as training resource, mentor and coach to others, particularly new hires. Identifies and shares best practices. Provides input into pharmacists? performance reviews. Demonstrates, advocates and reinforces a positive team environment, professionalism, and the need to present a positive image of the company when interacting with others.
-Coordinates clinical staff availability and activities surrounding new implementations, provide assistance with Requests For Proposals (RFPs), Requests For Information (RFIs), Best and Final Offers (BAFOs), and re-bid requests.
- Adheres to organizational policies and procedures and ensuring compliance with Federal laws, State laws and standards of practice which govern the profession of pharmacy. Maintains pharmacy records in accordance with all applicable State and Federal laws and regulations. Maintains clinical skills and knowledge of pharmacotherapy by reviewing the literature, continuing education, and any company provided in-services. Completes all mandatory company provided on-line courses. Attends and completes all employee development courses. Participates in mandatory on-call rotation when required by business needs.
- Makes outbound or takes inbound telephone calls to assist in various aspects of patient care and/or product distribution to/from practitioners, members, and pharmacies. These calls include, but are not limited to, comprehensive medication reviews, targeted medication reviews, call to practitioners about product awareness, and prior authorizations.
- Performs other duties as required.
  • Serves as subject matter expert for Med D. Performs prospective and/or retrospective drug utilization reviews and appeals review per Federal regulations. Coordinates the distribution of clinical drug information as well as educate staff on the use of pharmaceutical treatment regimens and criteria. Serves as a training resource, mentor, subject matter expert and coach to clinical pharmacists, and other clinical staff. Complies with all corporate and facility standard operating procedures, policies, guidelines, and work instructions.

    Essential Functions


    -Performs quality assurance reviews in accordance with federal and company standards to ensure accurate handling of issues/ identify training needs.
    - Reviews denial letters to better improve execution of CMS processes and requirements.
    -Works coverage determinations, redeterminations, etc. to ensure turn-around-times are met during high volume times.
    -Assists manager in identifying and delegating tasks to staff pharmacists in order to meet the needs of the Med D program.
    -Assists with client and internal reports for data validation and research escalated issues.
    - Collaborates with manager and other personnel in developing treatment guidelines and program enhancements. May participate in plan formulary development and criteria management.
  • Supports the Pharmacy and Therapeutics Committee. Coordinates clinical activities for new implementations.
    - Assesses, investigates and resolves escalated issues to achieve federal satisfaction, which may include medically necessary reviews, denial, and appeal processes. Ensures timely and accurate delivery of reports to clients and management.
    - Provides clinical and operational support to staff pharmacists. Serves as the technical on-site/remote resource. Assists with training for new clinical staff. Conveys clinical updates to team as required. Assesses training needs within team. Serves as training resource, mentor and coach to others, particularly new hires. Identifies and shares best practices. Demonstrates, advocates and reinforces a positive team environment, professionalism, and the need to present a positive image of the company when interacting with others.
    - Adheres to organizational policies and procedures and ensuring compliance with Federal laws, State laws and standards of practice which govern the profession of pharmacy. Maintains pharmacy records in accordance with all applicable State and Federal laws and regulations.
  • Maintains clinical skills and knowledge of pharmacotherapy by reviewing the literature, continuing education, and any company provided in-services. Completes all mandatory company provided on-line courses. Attends and completes all employee development courses. Participates in mandatory on-call rotation when required by business needs.
    - Makes outbound or takes inbound telephone calls to assist in various aspects of patient care and/or product distribution to/from practitioners, members, and pharmacies. These calls include, but are not limited to, comprehensive medication reviews, targeted medication reviews, call to practitioners about product awareness, and prior authorizations.
    - Performs other duties as required.

#LI-KB1

General Job Information

Title

Medicare D Senior Clinical Pharmacist

Grade

29

Job Family

Pharmacy Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

2/8/2019

Date Requisition Created

2/8/2019

Minimum Qualifications

Education

Bachelors: Pharmacy (Required), PharmD: Pharmacy (Required)

License and Certifications - Required

PharmD - Doctor Of Pharmacy, State Licensure - Pharmacy, RPH - Registered Pharmacist - Pharmacy

License and Certifications - Preferred

Other Job Requirements

Responsibilities

Strong drug product and clinical pharmacy knowledge.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled

Top 5 reasons to work at Magellan

When you say

To be the best you have to work with the best

We hear you
Life @ Magellan