Clinical Pharmacist - Managed Care

Clinical PharmacistThe Clinical Pharmacist will be responsible for the daily Clinical Pharmacist operations and decision-making process related to Part D Coverage Determinations. The Clinical Pharmacists will also be responsible for all aspects of Formulary maintenance and management. The Clinical Pharmacist may also be required to meet with prescribers on a one-on-one basis to promote cost-effective prescribing initiatives and strategies and will assist in the identification of cost-saving opportunities and outliers, the development of educational material, the evaluation of prescriber utilization data, and the deployment of cost reduction strategies. The Clinical Pharmacist will assist in the development, administration and management of the Health Plan's Medicare Prescription Drug Program, including compliance and oversight of Medicare Part D laws, regulations and reporting requirements, benefit configuration and benefit transition process, and drug reviews for Pharmacy & Therapeutics Committee Meeting. The Clinical Pharmacist will assist in the development and oversight of the Part D Drug Formulary and administration of the Drug Utilization Management Program. This includes weekly new drug reviews and coding to be submitted to the Pharmacy Benefit Manager, New Contract Year formulary evaluation, and rebate strategy evaluation. The Clinical Pharmacist may review and present New Drug Entities, New Generics, and Line Extensions at the Plan's Pharmacy & Therapeutics Committee Meeting. This position will work with other constituents, including but not limited to: Pharmacy Director, Chief Medical Officer, Medical Director, Pharmacy team, Member Services, Utilization Management, IT/Analytics, Finance, Case Management, Provider Relations, Compliance, Sales/Marketing and the PBM account team.Responsibilities:Formulary Management and FRF submissions in HPMSDrug Monographs for New Drug Entity ReviewsDevelopment of Education Material for ProvidersMember Medication Reviews for identification of Polypharmacy, Inappropriate prescribingPBM Rebate Strategy implementation and oversightPharmacy & Therapeutics Committee MeetingCMS Model Letter ReviewsCoverage Determinations and monitoring of optimal cost effective drug managementPerform medical necessity reviews for formulary exceptions and prior authorizations according to the Medicare Part D defined guidelinesWork with the Pharmacy Benefit Manager (PBM) and formulary manager to manage formulary changes and update the Plan's website to reflect the most up to date approved CMS versions of the formularyAssist providers with recommendations in an effort to promote cost-effective alternatives.Guide pharmacy technicians with clinical questions from prescribers, pharmacies, and/or membersEnsure clinical alignment of drug management across medical and pharmacy benefits, including identification of new opportunities for drug management, safety programs, and medical/pharmacy cost savingsMake recommendations on utilization management edits such as Prior Authorization, Step Therapy and Quantity LimitsProvide internal professional staff education regarding the pharmacy benefit and formularyAssist with the development and implementation of the Pharmacy Department's Policies and ProceduresResponsible for pharmacy oversight of member communications including correspondence associated with coverage determination decisionsReview prescription utilization data to identify outliers and trends, including high-cost drug category driversDevelop and implement cost-saving strategies for prescription drugsEvaluate medication regimens for members with polypharmacy and assist with medication reconciliationDevelop educational material for prescribers to communicate pharmacy cost-management initiativesVisit prescribers one-on-one and effectively communicate cost-effective drug recommendations.Perform oversight of progress seen with pharmacy cost-saving initiatives.Provide feedback to the Pharmacy Director and other key players in the organization.Perform other projects, work, and activities as assigned by the Pharmacy DirectorQualifications:Managed Care experience preferred, but not requiredPart D Coverage Determinations experience preferred, but not requiredPart D Formulary Management experience preferred but not requiredHPMS Formulary Reference File (FRF) submission experience preferred but not requiredStrong computer skills, such as Microsoft Office (Outlook, Word, Excel, Powerpoint, Access) . Programming or Reporting software skillsStrong Communication and Presentation SkillsDoctor of Pharmacy Degree (PharmD) or Bachelor of Pharmacy Degree (RPh) with clinical experience or Completion of, or currently enrolled in, residency program (PGY1) in managed care pharmacy, or pharmacy practice.Current and unrestricted State of Florida license.Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.No Third Party Agencies or Submissions Will Be Accepted. Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.