Job Description

Job Description

Title: Clinical Pharmacist

Duration: 3 months

Shift: 9am to 6pm EST

Responsibilities

• Reviews a completed prior authorization request received from the provider and/or reviews the pharmacy technician’s recommended denial, suggested formulary alternatives, comments and attachments for appropriateness.
• Verifies member’s ID number and date of birth.
• Verifies member’s eligibility in the appropriate health plan eligibility system.
• Records carrier and group number if applicable.
• Checks for previous prior authorization decisions.
• Verifies coverage in member’s prescription benefit when necessary.
• Verifies coverage in member’s health plan benefit when necessary.
• Evaluates prescription claim history.
• Reviews chart notes and/or lab values.
• Identifies provider specialty when appropriate.
• Applies Medical Policy Criteria to prior authorization requests.
• Evaluates whether request meets criteria for approval.
• Reviews the request using professional clinical judgment on a case by case basis. A pharmacist will review medication requests not addressed by P&T Committee criteria or guidelines, develop and draft criteria for the non-formulary medication requested.
• Researches and contributes drug references and clinical information to facilitate prior authorization review: directly to physicians via fax or phone encounter; or to pharmacy technicians via memo or on a personal level as an educational tool
• Communicates with physicians regarding prior authorization:
• For a non-formulary drug
• Plan benefits, exclusions
• Quantity limits
• Age restrictions
• Formulary alternatives
• Retrieves and collects data through available reporting resources (i.e. Discoverer, IT Department)
• Compiles data for reporting purposes:
• Drug utilization of non-formulary drugs
• Overturned IPS recommended denials
• Audit pharmacy claims greater than $200.00
• Suggest addition or deletion of drugs to/from the formulary
• Updating qty/days or age limit ends
• Support National P&T Committee
• Other tasks which may arise during the performance of any of the above mentioned duties.

Education/Certification Required : Pharm D.

Licensure Required : FL Pharmacist license

Must haves: At least one year of professional RPh experience

Nice to haves: Some experience working in managed care, understanding of Medicare/Medicaid law

Performance indicators:

• Sign 85 – 100 cases daily
• Self-Motivated/Good Time Management Skills
• Working Knowledge of Office Suite
• Goal Oriented

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