The Pharmacist Managed Care provides managed care clinical pharmacy-related services to include drug evaluation and support of formulary and PA criteria, compliance with regulatory and quality requirements, drug utilization management activities, medication therapy management and chronic disease management services.
ESSENTIAL FUNCTIONS OF THE ROLE
Participates in implementation of innovative solutions, new services and programs to ensure appropriate pharmaceutical utilization, improve patient outcomes, and control costs.
Performs Pharmacy Benefit Management (PBM) responsibilities to include implementation and maintenance of drug utilization review (DUR) edits, step therapy edits, prior authorization criteria, formulary management, benefit design, specialty drug management, and pharmacy and therapeutics (P&T) committee oversight/participation and support.
Coordinates, implements and maintains clinical pharmacy programs and initiatives.
Performs quality and regulatory activities; Routinely engages with vendors to implement and maintain processes and ensure compliance with internal requirements and regulatory governing bodies.
Develops, implements and maintains medical drug management strategies such as medical drug coverage policies, prior authorization processes, medical drug benefit configuration, and medical claim edits. Participates in medical management committees and workgroups in coordination with interdepartmental personnel.
Coordinates with medical management staff, providers and other key stakeholders.
Provides client support for pharmacy benefit management clinical operations; formulary, utilization management, clinical programs, etc. to meet client?s individual population needs.
Manages the activities of pharmacy support staff.
Prioritizes and organizes work to ensure timely completion and effective results in efficient manner. Routinely provides reporting and pertinent updates on projects to leadership.
KEY SUCCESS FACTORS
Self-motivated with the ability to work under minimal direction in handling moderately complex to complex projects.
Ability to work collaboratively with cross-organizational team to build positive relationships.
Demonstrated ability to manage multiple priorities and deadlines in a fast-paced environment.
Problem-solving, critical thinking skills and attention to detail.
Ability to interact and maintain professional working relationships with internal and external partners.
Strong verbal and written communication skills.
Minimal patient/member interaction.
Our competitive benefits package includes the following
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level
- EDUCATION - Doctorate
- MAJOR - Pharmacy
- EXPERIENCE - Less than 1 Year of Experience
- CERTIFICATION/LICENSE/REGISTRATION -
Pharmacist (RPH): Texas State Board of Pharmacy license required.
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