Location:

Work from home (Pennsylvania)

Shift:

Days (United States of America)

Scheduled Weekly Hours:

40

Worker Type:

Regular

Exemption Status:

Yes

Job Summary:

Depending on assigned area of expertise, the pharmacist will perform a variety of duties, including performing extensive literature review for the development of criteria for management of the pharmacy benefit, administering the pharmacy benefit in conjunction with the Health Plan Pharmacy Customer Service team members, delivering continuous, high quality member care while maximizing member satisfaction and managing appropriate utilization, among others duties assigned.

Job Duties:

• Act as a liaison between the Health Plan and its customers with respect to pharmaceutical benefits.
• Serves as formulary expert for all lines of business and associated benefit designs.
• Supports internal operations in their duties to provide information to our customers regarding pharmacy and medical drug benefits, formulary details, and prior authorization details as needed.
• Supports prior authorization representatives in their duties related to medical necessity, formulary exceptions, and prior authorization reviews.
• Perform medical necessity reviews for formulary exceptions and prior authorizations according to specified timelines.
• Such pharmacy utilization management activities will be performed only after obtaining an active, unrestricted pharmacy license.
• Perform extensive literature review and develop clinical criteria for new and existing pharmaceuticals as part of a drug review function to be presented at the Pharmacy and Therapeutics Committee.
• Works closely with clinical enterprise to coordinate the best, most cost effective, drug selection policies, and protocols for targeted disease processes.
• Suggests improvements and changes to perpetually improve operations.

Work is typically performed in a clinical environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. Additional competencies and skills outlined in any department-specific orientation will be considered essential to the performance of the job related to that position.

Position Details:

Education:

Bachelor's Degree-Pharmacy (Required)

Experience:

Certification(s) and License(s):

Licensed Pharmacist (Pennsylvania) within 90 days - State of PennsylvaniaState of Pennsylvania, Licensed Pharmacist - Default Issuing BodyDefault Issuing Body

Skills:

Application Delivery Process, Teamwork