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, Jacksonville , Clinical - Pharmacist 1, Healthcare , Raleigh, North Carolina