Clinical - Pharmacist 1
Company: Spectraforce Technologies
Location: Raleigh
Posted on: October 15, 2024
Job Description:
Title: Clinical - Pharmacist 1
Duration: 12 months
Location: Remote
Position Purpose:
- Provide timely drug therapy for Medicaid health plan members by
processing prior authorization and medical necessity
requests
- Direct resources to individual cases, projects, or critical
needs.
- Update health plan pharmacy documentation in conjunction with
state laws.
- Maintain relationships with all Clinet's health plan pharmacy
leadership regarding escalated claims
- Implement, maintain and provide training on all departmental
process and procedural documents, including prior
authorizations
- Manage prior authorization requests and pharmacists'
determinations for drug products according to member benefits and
coverage criteria
- Provide clinical guidance and support to the assigned
pharmacists and pharmacy technicians
- Responsible for setting criteria for medication analysis,
coordinate reports to clients, meet regulatory reporting
requirements for drug utilization review and fraud and abuse
reporting
- Develop clinical criteria for review of non-formulary or
non-preferred drug lists medications and communicate
recommendations to clients
- Oversee the drug utilization review and medication therapy
management programs at the assigned plan to meet Medicare Part D
requirements and develop systematic reviews of prescription claims
to meet strategic initiatives
- Ensure and evaluate quality controls and implement
opportunities for performance improvement in pharmacy
practices
- Research drug information to maintain drug knowledge and
disease state understanding for application to prior authorization
reviews
Qualifications
Education/Experience: Bachelor's degree or advanced degree
(PharmD., M.S) in pharmacy. 3+ years of retail or hospital pharmacy
experience or 1+ years of managed care pharmacy experience .
Clinical pharmacy experience in managed healthcare preferred.
License/Certification: Current state's Pharmacist license with no
restrictions. Additional license may be required as need by state
or contract.
Keywords: Spectraforce Technologies, Cary , Clinical - Pharmacist 1, Healthcare , Raleigh, North Carolina
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