What are the responsibilities and job description for the Clinical Pharmacist - Medicare position at Helping Hand Health?
Summary
In this role, a clinical pharmacist supports Medication Therapy Management (MTM) within a health plan environment. The role includes performing clinical medication reviews, identifying and resolving medication related issues, and supporting appropriate medication use. The pharmacist also completes pharmacy prior authorization reviews for pharmacy and specialty medications and ensures coverage determinations are clinically appropriate and compliant with regulatory requirements.
Key Responsibilities
- Conduct medication therapy management (MTM) services in alignment with CMS requirements, including comprehensive medication reviews and targeted interventions
- Perform clinical medication reviews and identify medication related problems
- Provide targeted interventions to problems identified through MTM reviews to improve adherence, safety, and therapeutic outcomes
- Review prior authorization requests for pharmacy and specialty medications using clinical guidelines consistent with CMS requirements
- Approve or deny pharmacy prior authorization requests with clear clinical rationale and appropriate supporting documentation
- Process pharmacy coverage determinations within required turnaround times (TAT)
- Apply formulary criteria, step therapy protocols, and utilization management guidelines to support appropriate medication use
- Contribute to quality improvement initiatives, including Medicare Star and HEDIS programs
- Provide drug information and clinical consultation to health plan members, providers, and care teams
- Collaborate with pharmacists, nurses, case managers, and other care team members to promote safe and effective medication use consistent with CMS and AHCCCS requirements
- Participate in clinical initiatives and special projects supporting pharmacy operations and member care gap closure.
Benefits & Schedule
- Compensation depends on experience
- Full-Time, in-office, Monday-Friday, 9:00am-5:30pm
- Medical, dental, vision, and life insurance
- 401(k) match eligible
- Paid time off
- Performance bonus eligible
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Application Question(s):
- Are you willing to consent to random drug screens and complete a background check?
Education:
- Doctorate (Preferred)
Experience:
- managed care, clinical pharmacy, or prior authorization: 1 year (Preferred)
- clinical training such as board certified pharmacotherapy: 1 year (Preferred)
- health plan or PBM: 1 year (Preferred)
- CMS, Medicaid, or AHCCCS: 1 year (Preferred)
- specialty drug management or coverage criteria policy: 1 year (Preferred)
License/Certification:
- Unrestricted Arizona Pharmacist License (Required)
Ability to Commute:
- Glendale, AZ 85308 (Required)
Work Location: In person