Clinical Pharmacist Job at UNITE HERE HEALTH
PURPOSE
The Clinical Pharmacist works to achieve better healthcare value and lower costs while ensuring quality pharmaceutical care. The purpose of this position is to provide support to the Pharmacy Benefit Manager (PBM). The Clinical Pharmacist will support clinical programs and utilization management. Utilization management responsibilities include review of prior authorization requests to make determinations for drug therapy according to member benefits and coverage criteria, creation and maintenance of pharmacy and medical drug therapy guidelines, development of clinical criteria for review of formulary exception and prior authorization requests, and determination and maintenance of applicable prescription limitations (age, gender, quantity, etc.). Other clinical programs include disease management, care management and drug management programs.
ESSENTIAL JOB FUNCTIONS AND DUTIES
Reviews formulary exception and prior authorization requests and make determinations for drug products according to member benefits, established treatment protocols and clinical criteria- Research drug information to maintain drug knowledge and disease state understanding for application to formulary exception and prior authorization reviews
- Supports the determination, appeal and grievance process for prescription and medical drug benefits
- Makes coverage determinations within the defined turnaround times and meet regulatory requirements
- Collaborates with the pharmacy director to research and synthesize detailed clinical data related to pharmaceuticals to identify opportunities for improving quality or overall cost
- Supports medical cost management, utilization management and medication management initiatives, projects, and related activities
- Supports Hospitality Rx’s efforts around researching, developing, and revising pharmacy and medical coverage guidelines
- Assists in the development of clinical criteria for the Pharmacy and Therapeutics Committee; participates in support of the Pharmacy and Therapeutics Committee
- Assists in Hospitality Rx’s efforts to develop and design clinical edits to adjudicate claims and enhance drug utilization
- Performs comprehensive and targeted medication reviews to identify, resolve, and prevent medication-related problems for targeted members
- Provides clinical guidance and support
- Utilizes prescription and medical claims data to generate clinical recommendations
- Serves as pharmacy subject matter expert (SME) on projects; support internal business partners such as care/case managers, health promoters and member services
- Provides internal professional staff and external member and provider education related to pharmaceuticals, disease states and program interventions.
- Collaborates with pharmacy director and manager to help with workflows and operational efficiencies
- Reviews and resolves complaints made by member and providers regarding formulary exception, prior authorization, formulary, or pharmacy services
- Assists in training and mentoring pharmacy students
- Set goals and achieve measurable results
- Contributes ideas to plans and achieving department goals
- Demonstrates the Fund’s Diversity and Inclusion (D&I) principles in their conduct at work and contributes to a safe inclusive culture with equitable opportunities for success and career growth
- Exemplifies the Fund’s BETTER Values in contributing to a respectful, trusting, and engaged culture of diversity and inclusion
- Performs other duties as assigned within the scope of responsibilities and requirements of the job
- Performs Essential Job Functions and Duties with or without reasonable accommodation
ESSENTIAL QUALIFICATIONS
Must be fully vaccinated for COVID-19
Years of Experience and Knowledge
- 5 ~ 7 years of direct experience minimum
- 0 ~ 2 years of experience in a managed care environment or clinical management role preferred
Education, Licenses, and Certifications
- Bachelor's degree in Pharmacy with optional post-graduate training or related field or equivalent work experience required
- Doctor of Pharmacy (PharmD)
- Required: Valid Illinois Pharmacist License
Skills and Abilities
- Ability to work M~F 11am ~ 7pm (CT)
- Analytical, research and development skills
- Communication skills (written and verbal)
- Organizational, team, deductive reasoning, problem solving, and decision-making skills
- Ability to work collaboratively with all levels of staff
- Ability to provide effective leadership
Salary range for this position: $133,300~$173,200. Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.
We reward great work with great benefits. The benefits we offer include but are not limited to: Medical/Dental/Vision benefits, Paid Time-Off (PTO), Paid Holidays, Short & Long-Term disability, Life & Accidental death, Pension, 401(k), Tuition Assistance, Employee Assistance Program (EAP), Healthcare Flexible Spending Accounts (HFSA) and Dependent Care Flexible Spending Account (DCFSA).
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