Clinical Advisor- Pharmacist

Job Summary:

The Clinical Advisor is responsible for utilizing pharmacy acumen, medication expertise, and healthcare payer knowledge related to drug-related prior authorization requirements and medication guidelines to support PA operations (in completing PA reviews), PA technology and automation, consultation on evidence-based guidelines and pharmacy policy, reporting and analytics, and quality management programs. The Clinical Advisor will collaborate with a team of pharmacy technicians and pharmacists in Pharmacy Operations.

Job Responsibilities  

•                    Serves as a subject matter expert in the development and maintenance of drug formularies and clinical programs.

•                    Coordinates activities as part of the Formulary Development and Maintenance team and recommends measures to improve performance and efficiency.

•                    Manage operations of the Pharmacy & Therapeutics (P&T) Committee including scheduling drug class reviews, reviewing new branded agents, coordinating internal/external membership, documenting P&T minutes, and preparing and organizing P&T files.

•                    Performs clinical reviews of PA, Step Therapy, Quantity Limit, and all other pharmacy utilization requests in accordance with quality, timeliness, and efficiency standards.

•                    Performs coverage determinations and appeals requests according to criteria guidelines and in compliance with all state and federal regulations, including Medicare and Medicaid.

•                    Develops and implements clinical utilization criteria for new market entries and market updates utilizing evidence-based medicine principles.

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Qualifications:  

           Education and/or Training:

           • Doctor of Pharmacy (PharmD) degree from an ACPE accredited college is required.

           • Managed Care or Clinical Residency program residency highly preferred.

           Professional Experience:

           • At least 1 year of recent managed care experience in a PBM or health plan setting.

           • Experience with Medicare Part D highly preferred.

           • Expert knowledge of the principles and practices of pharmaceutical science, a working knowledge of managed care and policy development as well as working knowledge of state and federal controlled substances and related laws, rules, and regulations.

           • Experience using clinical resources, e.g., Micromedex, Lexicomp, Clinical Pharmacology.

           Licenses/Certifications:

           Registered and in good standing with the Board of Registration in Pharmacy.

           Active, non-restricted pharmacist license.