PBM Pharmacist: Formulary, Coverage & Policy

OHSU; Beaverton (OR); On-site; USD 110,000 - 150,000; Full time

Benefits offered by this job

Healthcare options

Pension plans

Vacation

Sick leave

Holidays

Transit discounts

Tuition reimbursement

Employee Assistance Program (EAP)

Job summary

OHSU in Oregon seeks a PBM Pharmacist to provide clinical support for Pharmacy Benefit Management Services, including formulary management, coverage determinations, and committee support.

Responsibilities include responding to inquiries, completing prior authorization requests with PBM Technicians, and using claims data to optimize drug spend and outcomes. Requires Oregon Pharmacist license; preferred candidates have PBM or managed care experience.

Qualifications

• Current Pharmacist license issued by the Oregon State Board of Pharmacy.
• OHSU may require training or experience in a specialized area at time of recruitment.
• Strong knowledge of drug therapy and contemporary medication-use systems.

Responsibilities

• Formulary management including adjudication, formulary decision making, and benefit determination.
• Respond to and resolve clinical inquiries from members, clients, providers, or pharmacies related to formulary options, therapeutic alternatives, and coverage determinations.
• Complete prior authorization requests for members through collaboration with PBM Pharmacy Technicians.
• Coordinate with pharmacy claims processor to ensure formularies, clinical edits, and plan designs are implemented according to requirements.
• Assist with developing and presenting drug monographs, executive summaries, therapeutic class reviews, and medication policies to Pharmacy & Therapeutics Committees.
• Utilize claims data to evaluate benefit design for inappropriate utilization and opportunities to improve outcomes and optimize drug spend.

Skills

Pharmacist license

PBM experience

Drug information

Communication

Organizational skills

Education

Pharmacy degree (BS Pharmacy or Pharm.D.)

Job description

OHSU in Oregon seeks a PBM Pharmacist to provide clinical support for Pharmacy Benefit Management Services, including formulary management, coverage determinations, and committee support.

Responsibilities include responding to inquiries, completing prior authorization requests with PBM Technicians, and using claims data to optimize drug spend and outcomes. Requires Oregon Pharmacist license; preferred candidates have PBM or managed care experience.