Job Description
Title Pharmacist I
Duration - 12 months + possible extension
Shift - 8 am to 5 pm
Location - Remote
Pay rate: $58.00-60.00/hr
Description
- 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 Centene 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.
Job Tags
Contract work, Shift work,