Pharmacist Health Plan

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

This position is primarily focused on medication therapy management (MTM) outreach for Medicare Part D members.

Education

Experience

Bachelor's Degree-Pharmacy (Required), Bachelor's Degree- (Preferred)

Certification(s) and License(s)

Licensed Pharmacist - Default Issuing Body; Licensed Pharmacist (Pennsylvania) within 90 days - State of Pennsylvania

OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.