Job SummaryManaged care pharmacists are responsible for ensuring patient access to appropriate and cost-effective medication therapies. Pharmacists in this role support a variety of services including developing and implementing evidence-based clinical programs and quality-oriented drug management services, instituting practices to ensure patient safety, communicating and collaborating with patients, prescribers, pharmacists, internal and external clients, contributing to the design of pharmacy benefits, managing quality and cost effectiveness, and involvement in the medication distribution process in the managed care setting.
Essential Functions- Performs day to day clinical pharmacy functions including prior authorization and appeal reviews.
- Uses clinical expertise to make coverage determinations and ensure adherence to prior authorization protocols, formulary status, medical necessity and contract criteria.
- Analyzes pharmacy and medical spend data (total cost of care, drug and medical trends) and coordinates development of appropriate use standards, prior authorization protocols, and guidelines.
- Supports drug formulary development and management.
- Participates in strategies and clinical programs that ensure appropriate and cost-effective medication use, through principles of drug utilization management and medication optimization.
- Works with medical directors, pharmacy leaders, and medical management teams to provide drug information support to promote optimal quality of care and efficient use of resources.
- Participates in clinical and operational process improvement and cost savings opportunities.
- Supports clinical initiatives related to NCQA, HEDIS, CAHPS, STAR measures, and other clinical quality and programs. Adheres to Pharmacy Policies and Procedures.
QualificationsRequired
- Doctorate Doctor of Pharmacy degree from an accredited College of Pharmacy
- LIC-Clinical Pharmacist - STATE_MI State of Michigan Upon Hire Or
- LIC-Clinical Pharmacist - STATE_OTHR State Other than Michigan Upon Hire
Preferred
- 2 years of relevant experience managed care pharmacy experience or completion of a Managed Care Pharmacy Residency
- 2 years of relevant experience Familiarity with the Michigan health care market and provider groups and practices
Primary LocationSITE - Priority Health - 1231 E Beltline Ave NE - Grand Rapids
Department NamePharmacy Operations - PH Managed Benefits
Employment TypeFull time
ShiftDay (United States of America)
Weekly Scheduled Hours40
Hours of Work8 a.m. to 5 p.m.
Days WorkedMonday to Friday
Weekend FrequencyOn-call weekends
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