PRIMARY PURPOSE: The Clinical Review Pharmacist has the responsibility of reviewing the medical necessity, appropriateness, and quality in the appropriate setting for workers’ compensation injured employee as it pertains to their medications. Additionally, they will work with Amtrust adjusters and nurses to take proper interventions in the care of the injured employee. This position primarily requires timely reviews of pharmacy prior authorizations to determine appropriateness and medical necessity of treatment. This position assesses the medical appropriateness of proposed medications for our injured employees and partners with the AmTrust claims team to expedite medically necessary treatment.

• Review prescription prior authorizations in the timeliest manner.
• Any supporting clerical tasks associated with pharmacy authorizations/reviews.
• Document medication determination based on professional clinical judgement, evidence-based guidelines, clinical treatment guidelines, state specific workers’ compensation formularies, and third-party Utilization Review when appropriate.
• Document judgement on medication determinations on multiple platforms.
• Recommend to the appropriate party alternative medications, alternative dosing, or other modifications (including discontinuation of medications) as appropriate.
• Reviews therapy plans with case nurses as needed.
• Escalate cases for multi-disciplinary reviews.
• Telephonic engagement with providers for peer-to-peer interventions
• Participate in clinical quality audits for inter-rater reliability assurance and support
• Pharmacists review medication orders for completeness, accuracy, and legality, determining the presence of medication therapy problems in a patient’s current medication therapy, including, for example, any of the following:
  • Medication prescribed inappropriately for a particular medical condition
  • Current medication therapy regimen is inappropriate (dose, dosage form, duration, schedule, route of administration, method of administration)
    • There is therapeutic duplication
• Provide pharmacological information by answering questions and requests of health care professionals and adjusters
• Maintain privacy and confidentiality of all records while adhering to ethical, legal, and regulatory standards.
• Ability to work independently and prioritize workload

Qualifications:

• 3+ year of experience in pharmacy clinical care
• Pharmacy B.S or Pharm D
• Strong documentation skills
• Strong communication and presentation skills

Preferred experience:

• Prior Authorization
• Pain management treatment protocols and clinical guidelines
• Excellent oral and documentation communication skills
• MTM certifications
• Workers’ compensation managed care treatment
• Clinical guidelines and formulary management

The expected salary range for this role is $116,000-$120,000.00. 

Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations.

This job description is designed to provide a general overview of the requirements of the job and does not entail a comprehensive listing of all activities, duties, or responsibilities that will be required in this position. AmTrust reserves the right to revise this job description at any time.

AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.