The Pharmacy Consultant will review Medicaid Prior Authorizations based on medical necessity in accordance with State policy guidelines, provide guidance and support for Medicaid Providers when appropriate, and act as a clinical SME (or liaison) for internal DXC entities. Note: This is not a patient facing position.
Primary Job Responsibilities:
- Adjudicating pharmacy prior authorizations based on medical necessity and eligibility, in accordance with State policy guidelines and accepted pharmacy practices.
- Reviewing and evaluating prior authorization submissions utilizing multiple computer systems, and when appropriate seeking additional information or clarification from requesting Provider
- Entering prior authorization outcome into the Medicaid Management Information System (MMIS) for processing.
- Participation in monthly meetings which include DXC leadership, operational staff support, clinical peers and State stakeholders.
- Providing assistance and education to the provider community related to specific prior authorization submissions, when applicable.
- Offering analysis and recommendations to DXC and State leadership on methods and potential process improvements related to the administration and application of the pharmacy program.
- Review communications to providers and members on new/revised policies.
•Must be a graduate of a recognized and accredited School of Pharmacy
•Must be a registered pharmacist in the State of Wisconsin
•Must have professional knowledge of medication, supplies, and equipment used
•Medication knowledge must be current
•Ability to maintain a good working relationship with professional and non-professional people
•Must have ability to make judgments and decisions as necessary in areas of procedures and appropriateness of drug therapy
•Must be able to set priorities
PharmD degree is required for this position.
Licenses and Certifications:
Minimum - Licensed to practice pharmacy in the State of Wisconsin
Required Skills, Knowledge, and Abilities:
- Ability to make judgments in demanding situations
- Ability to react to frequent changes in duties and volume of work
- Ability to logically organize details
- Comfortable accepting responsibility for medium to large scale projects involving multiple resources and spanning many months from start to finish
- Ability to manage multiple concurrent activities