*Pharmacist - Clinical Pharmacist

ASK Consulting; New Shoreham (RI); Sur place; USD 110 000 - 140 000; Plein temps

Résumé du poste

ASK Consulting seeks a Clinical Pharmacist to resolve coverage determinations and redeterminations timely. You will interact with health care professionals by phone or fax to coordinate patient care and support providers.

The role requires a Pharm D. with an active state license and at least 1 year of clinical pharmacy experience, preferably with managed care (Medicaid/Medicare). Strong communication and Excel/SharePoint skills are important.

Qualifications

• Pharm D. required with active license in good standing.
• Active license must be in the state of residence with no restrictions.
• Experience with prior authorization is preferred.
• Knowledge of managed care (Medicaid/Medicare) preferred.
• Strong communication and documentation skills.

Responsabilités

• Complete clinical reviews for Medicare-Medicaid Coverage Determination/Redetermination and other determinations by reviewing requests per criteria.
• Monitor Prior Authorization process quality and communication with prescribers and members; provide recommendations to physicians.
• Complete annual NCQA, Aetna required training requirements.
• Assist Member Services and internal customers with pharmacy-related inquiries.
• Maintain open lines of communication with other departments.
• Stay current with clinical literature and relay findings to program development teams.

Connaissances

Clinical pharmacy experience

Active state license

Prior authorization experience

MS Office

SharePoint

Strong communication

Managed care experience

Board certification

Residency preferred

Formation

Pharm D. degree

Description du poste

Description

Job Title

Clinical Pharmacist

Position Description

This position is responsible for resolving coverage determination/redetermination reviews in a timely manner. There may be some interaction with the health care professionals in the provision and coordination of customer care. Must be comfortable communicating by telephone or fax, with patients and physicians for patient care.

Roles Responsibilities

• Complete Clinical Reviews and provide a determination of Medicare-Medicaid Coverage Determination/Redetermination, Global Exception etc. by reviewing all requests which are not clearly approvable based on specified criteria (algorithms).
• Continually monitor the quality and efficiency of the Prior Authorization process including coverage criteria, denial language, and communication with prescribers and members. Provide recommendations to physicians to improve medication regimens as appropriate.
• Complete all annual NCQA, Aetna required training requirements.
• Assists Member Services and other internal customers in responding to and resolving pharmacy-related inquiries from members (NCQA Requirement).
• Maintain open lines of communication with other functional areas/departments.
• Responsible for staying current with clinical literature and guidelines and relaying those to the program development core teams.

Skills

• Previous pharmacy experience in clinical settings preferred.
• Appropriate state license required.
• Experience in prior authorization is preferred.
• Basic computer skills required.
• Strong organizational skill, interpersonal skills, and detail orientation important for this position.
• Proficiency in Microsoft Excel, Word, Outlook, and SharePoint.
• Superior written and verbal communication skills.
• Will consider a recent grad with an active license.
• Managed care experience (Medicaid/Medicare) preferred.
• 1+ year of previous clinical pharmacy experience required.
• 2+ years of experience working as a pharmacist (managed care experience is highly desirable, but not required).
• Knowledge of clinical program components, formulary designs, and prescription benefit trends preferred.
• Board certification and managed care residency preferred.

Education

• Pharm D. required. Must have an active license in good standing. License should be active within the state they reside in with no history or restrictions.