Description

Make a meaningful impact where expertise and compassion come together.
Our oncology clinic is seeking a dedicated Clinical Pharmacist to play a vital role in optimizing cancer treatment outcomes and enhancing patient care. As a trusted medication expert and collaborative healthcare partner, you will help ensure patients receive safe, effective, and evidence-based therapies while supporting them throughout their treatment journey.

Job Summary: We are seeking a highly motivated and detail-oriented Clinical Pharmacist to join our team. In this role, the Clinical Pharmacist will be responsible for conducting clinical order reviews, managing prior authorizations, handling medication-related appeals, and drafting letters of medical necessity. The ideal candidate will have strong clinical knowledge, excellent communication skills, and a thorough understanding of medication therapy management in various healthcare settings.

Job Duties / Responsibilities:

1. Clinical Order Review:
• Review medication orders for appropriateness, accuracy, and safety.
• Ensure that prescriptions align with clinical guidelines, drug formularies, and patient-specific factors (e.g., allergies, comorbid conditions).
• Collaborate with physicians, nurses, and other healthcare providers to clarify and resolve medication-related issues.

2. Prior Authorization:
• Review and process medication requests for prior authorization (PA) according to payer guidelines and formularies.
• Communicate with healthcare providers and insurance companies to obtain necessary approvals for medications.
• Stay current with payer policies and clinical guidelines to ensure compliant and timely approvals.

3. Appeals Management:
• Handle and manage medication-related appeals for denied claims, including reviewing denial letters, gathering supporting documentation, and writing effective appeal letters.
• Collaborate with healthcare providers to ensure accurate and compelling case presentation.
• Ensure timely submission and follow-up on all appeals to resolve denial issues and secure medication access.

4. Letters of Medical Necessity:
• Draft clear and concise Letters of Medical Necessity (LMNs) to support insurance claims, demonstrating the clinical necessity of specific treatments or medications.
• Work with healthcare providers to gather appropriate clinical documentation and patient history to strengthen the case.
• Ensure LMNs are submitted in a timely manner and in compliance with insurance requirements.

5. Collaboration and Communication:
• Act as a liaison between healthcare providers, patients, insurance companies, and other stakeholders to ensure medication access and optimal patient care.
• Educate patients, physicians, and other healthcare providers on medication therapy management, formulary requirements, and insurance-related processes.
• Provide recommendations for alternative medications, when necessary, based on formulary restrictions.

6. Continuous Learning:
• Stay updated on the latest clinical guidelines, drug therapies, insurance policies, and industry trends related to prior authorization and appeals processes.

Participate in relevant professional development activities to enhance clinical knowledge and practice.

Requirements

Required Skills/Abilities:

Experience:
• Minimum of 2 years of clinical pharmacy experience, preferably in specialty or multi-disciplinary fields.
• Experience with reviewing clinical orders, processing prior authorizations, and managing appeals strongly preferred.

Skills:
• Exceptional communication and writing skills, particularly in drafting medical necessity letters and appeal letters.
• Ability to navigate payer guidelines, formularies, and insurance protocols.
• Detail-oriented with the ability to manage multiple tasks and priorities efficiently.
• Strong problem-solving skills and ability to collaborate effectively with healthcare providers and insurance representatives.

Technical Skills:
• Proficiency with pharmacy management software, electronic medical records (EMRs), and Microsoft Office Suite (Word, Excel, PowerPoint).
• Familiarity with insurance claims processes and formulary management.

Certifications/Licenses/Education/or Experience in a related field

Education:
• Doctor of Pharmacy (PharmD) degree from an accredited pharmacy school.

Licensure:
• Active pharmacist license in the state of Arkansas

Physical Requirements:
• Sitting for prolonged periods of time at a desk.
• Computer use that requires visual acuity, typing, use of mouse/keyboard, and staring at a screen for extended periods of time.
• Occasionally lifting objects of up to 25 pounds such as files, office supplies, assisting patients when needed, etc.
• Walking and standing for continuous periods around the office or clinic as needed.
• Fine motor skills for tasks like typing, writing, handling small objects or equipment and materials.

Work Environment:

• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. Reasonable accommodation may be provided to enable individuals with disabilities to perform essential functions.
• Due to the nature of our business and the use of radiation and hazardous chemicals, it is imperative that all employees foster a culture and environment of safety.
• Safety Sensitive: In accordance with the Arkansas code this position is designated as a safety sensitive position wherein the employee performing the job duties under the influence may constitute a threat to health or safety.