Clinical Pharmacist- Prior Authorization (Medicaid)Primary Location: Phoenix, Arizona
Additional Locations: AZ-Phoenix, TX-Houston Apply
Performs prospective and/or retrospective drug utilization review. Coordinates the distribution of clinical drug information and educates providers and staff regarding the appropriate use of pharmaceutical treatment regimens.
61027Fundamental Components: Improves quality of service to members by providing prior-authorization of formulary drugs, developing programs to provide optimal pharmacy care to patients, participating in dispute resolution of drug utilization review, measuring and documenting improvements in patient care, and/or improving claim adjudication for proper provider reimbursement. Collaborates with other medical personnel in developing treatment guidelines and demonstrates the impact of these guidelines. May participate in formulary development and management. Monitors prescribing habits of participating physicians. Makes recommendations to physicians to improve medication regimens as appropriate. Maintains the non-formulary exception program and/or the rebate program consistent with contract, state and/or federal guidelines. May audit providers to ensure accurate dispensing and billing of products. Collaborates with the pharmaceutical community to ensure timely payment is maintained. May support the drug rebate regulations and mandates by maintaining pharmaceutical reimbursement methodology for multisource products. Validates the clinical availability of multisource products for provider utilization. May assist the client with rebate reporting requirements. Supports the Pharmacy and Therapeutics Committee function. May develop and maintain a newsletter for provider staff, promoting rational prescribing habits. Performs other duties as required. Background Experience: -Current unrestricted state pharmacist license required for Texas or Arizona
-1+ year of pharmacist experience required
-Understanding of medical and pharmacy terminology required
-Knowledge of clinical program components, formulary designs, and prescription benefit trends preferred
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