Clinical Policy Specialist (Pharmacist)
Company Name:
WorkStaff USA Staffing Agency
Position Purpose: Provide timely drug therapy for Medicaid health plan members by processing prior authorization and medical necessity requests for specialty medications.
Review specialty medication prior authorization requests (i.e. biopharmaceuticals) according to established treatment protocols, clinical criteria and member benefits. and 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 and 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
Qualifications:
Education/
Experience: Bachelors degree or advanced degree (PharmD., M.S) in pharmacy. 5
years of mail order, retail or hospital pharmacy, including 1
years of specialty medication pharmacy experience or experience in the Clinical Pharmacist role at US Script, Centene or its subsidiaries.
License/Certification: Pharmacist license.
#LI-MH1
Employee Status:
Regular
Job Level:
Staff
Job Type:
Regular
More Information About the Job
What are the top 3-4 things the person in this position will be challenged with in the first 60-90 days?
Fast paced work environment
What are we looking for on the resume, and why?
Technical writing/research skills, Aptitude for writing/research, writing policies and procedures/publishing articles and White papers as well as develop initiatives and programs with pharmacy practice, Formulary Develeopment.
This position will be charged with the revision and development of new and existing clinical policies for specialty medications.
In the job description the following are the major duties of this role.
(Major) Develop and review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design
(Major- remaining knowledgeable) Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
(Minor) Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practice specific to specialty pharmacy
What are we willing to be flexible on, and how?
Post graduate training in Drug info
Is this a replacement or a new position?
New position
Who will the person in this position interact with?
will report findings to management teams
Are we ready to hire the right candidate immediately?
Yes
Is relocation available?
YesEstimated Salary: $20 to $28 per hour based on qualifications.
WorkStaff USA Staffing Agency
Position Purpose: Provide timely drug therapy for Medicaid health plan members by processing prior authorization and medical necessity requests for specialty medications.
Review specialty medication prior authorization requests (i.e. biopharmaceuticals) according to established treatment protocols, clinical criteria and member benefits. and 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 and 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
Qualifications:
Education/
Experience: Bachelors degree or advanced degree (PharmD., M.S) in pharmacy. 5
years of mail order, retail or hospital pharmacy, including 1
years of specialty medication pharmacy experience or experience in the Clinical Pharmacist role at US Script, Centene or its subsidiaries.
License/Certification: Pharmacist license.
#LI-MH1
Employee Status:
Regular
Job Level:
Staff
Job Type:
Regular
More Information About the Job
What are the top 3-4 things the person in this position will be challenged with in the first 60-90 days?
Fast paced work environment
What are we looking for on the resume, and why?
Technical writing/research skills, Aptitude for writing/research, writing policies and procedures/publishing articles and White papers as well as develop initiatives and programs with pharmacy practice, Formulary Develeopment.
This position will be charged with the revision and development of new and existing clinical policies for specialty medications.
In the job description the following are the major duties of this role.
(Major) Develop and review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design
(Major- remaining knowledgeable) Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
(Minor) Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practice specific to specialty pharmacy
What are we willing to be flexible on, and how?
Post graduate training in Drug info
Is this a replacement or a new position?
New position
Who will the person in this position interact with?
will report findings to management teams
Are we ready to hire the right candidate immediately?
Yes
Is relocation available?
YesEstimated Salary: $20 to $28 per hour based on qualifications.
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