Clinical Pharmacist — Payer & Formulary Strategy

nirvanaHealth | RxAdvance; Southborough (MA); Sur place; USD 90 000 - 120 000; Plein temps

Résumé du poste

nirvanaHealth, operating under RxAdvance Corp., seeks a Clinical Advisor to apply pharmacy expertise and payer knowledge to PA reviews, policy, analytics, and quality programs. You will collaborate with pharmacy technicians and pharmacists in Pharmacy Operations to support PA processes.

Responsibilities include formulary development, data translation for design, and coordinating P&T activities to optimize clinical and operational outcomes.

Qualifications

• Bachelor’s degree in pharmacy or related field. ACPE accreditation preferred.
• PharmD degree preferred; managed care residency highly preferred.
• Experience in managed care or PBM settings is desirable and relevant.

Responsabilités

• Serve as SME in drug formularies and clinical programs.
• Translate client requirements into technical design and data flow for development and configuration.
• Coordinate Formulary Development and Maintenance activities to improve performance.
• Conduct utilization management research and develop criteria for new markets.
• Perform PA, Step Therapy, Quantity Limit reviews consistent with regulations.
• Handle coverage determinations and appeals per regulatory guidelines including Medicare/Medicaid.
• Interact with stakeholders to support PA processes and timely responses.
• Develop utilization criteria for market updates and provide evidence-based recommendations.
• Support FWA program oversight and report suspected fraud.

Connaissances

Pharmacy acumen

Payer knowledge

Clinical decision-making

Formation

Bachelor’s degree in pharmacy

PharmD preferred

ACPE accreditation preferred

Outils

Micromedex

Lexicomp

Clinical Pharmacology

Description du poste

nirvanaHealth, operating under RxAdvance Corp., seeks a Clinical Advisor to apply pharmacy expertise and payer knowledge to PA reviews, policy, analytics, and quality programs. You will collaborate with pharmacy technicians and pharmacists in Pharmacy Operations to support PA processes.

Responsibilities include formulary development, data translation for design, and coordinating P&T activities to optimize clinical and operational outcomes.