Job description
Serves as client or subject matter expert for an assigned client and/or program. Performs prospective and/or retrospective drug utilization reviews and appeals review per State and Federal regulations. Coordinates the distribution of clinical drug information as well as educate staff on the use of pharmaceutical treatment regimens and criteria. Serves as a training resource, mentor, subject matter expert and coach to clinical pharmacy technicians, and other clinical staff. Complies with all corporate and facility standard operating procedures, policies, guidelines, and work instructions.
Strong drug product and clinical pharmacy knowledge.
PharmD required. Current incumbents grandfathered without the PharmD.
- Acts as prior-authorization liaison to the client and to the account management team.
- Advises and assists with clinical edit implementation, participates in appeals determination at the client level.
- Measures and reports on required contractual requirements.
- Assists with client and internal reports for data validation and research escalated issues.
- Collaborates with clinical account manager and other personnel in developing treatment guidelines and program enhancements.
- Participates in plan formulary development and criteria management as required by the client.
- Supports the Pharmacy and Therapeutics Committee.
- Validates the clinical availability of multisource products for provider utilization.
- Coordinates clinical activities for new implementations.
- Assesses, investigates and resolves escalated issues to achieve client satisfaction, which may include Peer to Peer reviews, denial, and appeal processes.
- Ensures timely and accurate delivery of reports to clients and management.
- Provides clinical and operational support to staff pharmacists.
- Serves as the client-specific technical on-site resource.
- Assists with training for new clinical staff.
- Conveys clinical updates to team as required.
- Assesses training needs within team.
- Serves as training resource, mentor and coach to others, particularly new hires.
- Identifies and shares best practices.
- Provides input into pharmacists' performance reviews.
- Demonstrates, advocates and reinforces a positive team environment, professionalism, and the need to present a positive image of the company when interacting with others.
- Coordinates clinical staff availability and activities surrounding new implementations, provide assistance with Requests For Proposals (RFPs), Requests For Information (RFIs), Best and Final Offers (BAFOs), and re-bid requests.
- Adheres to organizational policies and procedures and ensuring compliance with Federal laws, State laws and standards of practice which govern the profession of pharmacy.
- Maintains pharmacy records in accordance with all applicable State and Federal laws and regulations.
- Maintains clinical skills and knowledge of pharmacotherapy by reviewing the literature, continuing education, and any company provided in-services. Completes all mandatory company provided on-line courses.
- Attends and completes all employee development courses.
- Participates in mandatory on-call rotation when required by business needs.
- Makes outbound or takes inbound telephone calls to assist in various aspects of patient care and/or product distribution to/from practitioners, members, and pharmacies. These calls include, but are not limited to, comprehensive medication reviews, targeted medication reviews, call to practitioners about product awareness, and prior authorizations.
Other Job Requirements
Responsibilities
3+ years of experience as a clinical pharmacist required.
Strong drug product and clinical pharmacy knowledge.
PharmD required. Current incumbents grandfathered without the PharmD.
General Job Information
Title
Medicare D Senior Clinical Pharmacist
Grade
29
Work Experience - Required
Pharmacy
Work Experience - Preferred
Education - Required
Bachelors - Pharmacy, PharmD - Pharmacy
Education - Preferred
License and Certifications - Required
PharmD - Doctor Of Pharmacy, State Licensure - Pharmacy, RPH - Registered Pharmacist - Pharmacy
License and Certifications - Preferred
Salary Range
Salary Minimum:
$93,955
Salary Maximum:
$159,725
This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
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