Clinical Formulary Pharmacist

Centene Corp   •  

Fresno, CA

Industry: Healthcare

  •  

Less than 5 years

Posted 28 days ago

Description:

Position Purpose: Define and develop standard and custom formularies for all lines of business including Commercial, Medicaid, Medicare Part D and the Health Information Marketplace


Develop drug product review and formulary recommendations by assessing drug use trends, new drug releases and review of primary literature

Analyze pharmacy cost of care, trends, and coordinate the development of appropriate use protocols and guidelines

Set 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

Develop and design clinical edits to adjudicate claims and enhance drug utilization

Develop and review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design

Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews

Provide clinical guidance and support to the assigned pharmacy technicians

Provide support documentation and develop communication for the Pharmacy &Therapeutic (P&T) Committee review process and decisions

Qualifications:


Education/Experience: Bachelor's degree or advanced degree (PharmD., M.S) in pharmacy. 3+ years of combined managed care pharmacy or pharmacy residency program experience.


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