Overview Of Position
The Clinical Pharmacist is the primary staff clinician and drug information specialist for the Texas Medicaid single pharmacy benefit (SPBM) account. The Clinical Pharmacist is responsible for preparing clinical reports, drug monographs, doing prior authorizations and preparing and/or presenting information to the various boards (i.e. DUR Board) and committees (i.e. P&T Committee). The Clinical Pharmacist also assists the Data Analysts by providing clinical criteria for reporting.
What Will Be My Duties And Responsibilities In This Job?
- Actively support the Pharmacy Account Manager and Clinical Account Manager;
- Serve as the Contractor’s drug information specialist
- Serve as Contractor’s subject matter expert for Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes pertaining to drugs, including the pricing of procedure coded drugs dispensed by non-pharmacy providers such as practitioner offices and outpatient clinic settings
- Attend professional association meetings, as required by DMS
- Manage clinical call center and other issues related to drug prior authorizations
- Monitor prior authorization trends and make clinically and financially sound recommendations to DMS
What Are The Requirements Needed For This Position?
- Licensed registered Washington Pharmacist with 3-5+ years of hospital, home infusion, community & long-term care pharmacy practice experience
- 3-5+ years of experience with the government or a private sector health care payer
- 3-5+ years of experience with claims processing systems (including Medicaid)
- 3-5+ years of experience with drug information systems
- What other skills/experience would be helpful to have?
- Previous experience with clinical call centers with large healthcare payers
- Experience with Pharmacy Benefit Managers (PBM’s).