Clinical Pharmacist

Position Description:

• Review Part D coverage determination and appeal requests, making clinical decisions based on formulary benefits, guidelines, and CMS requirements.

• Perform computer-based tasks and make phone calls to providers when clinical information is needed.

• Consult with physicians and providers on questions and interpretations of clinical guideline criteria and coverage determinations.

• May conduct comprehensive medication reviews over the phone for members enrolled in the Medication Therapy Management program

• May participate in pharmacy quality initiatives and perform the Care for Older Adults Medication Review (COA-MDR).

• Support various Pharmacy Department operations, programs, and initiatives as needed.

• Perform other related duties and projects as assigned.

• Maintain productive working relationships with team members, internal and external customers, and management.

Requirements:

• BS in Pharmacy or Pharm D degree

• Pharmacist license in good standing.

• Minimum of 1 year of experience in a health plan and/or PBM.

• Previous work experience with Medicare Part D.

• Previous experience in CDAG (coverage determinations, appeals, and grievances).

• Previous work experience in Medication Therapy Management preferred

• Ability to work an 8-hour shift within the hours of 8:00am to 9:00pm Monday

• Friday, including Saturdays (7:00am

• 6:00pm) by rotation.

• Intermediate or higher proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint.

• Ability to work independently as well as part of a team.

Pay Range: $130,000 - $135,200 annually.