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Clinical Pharmacist (Prior Authorizations)

Company: CalOptima
Location: Orange
Posted on: May 13, 2019

Job Description:

The Clinical Pharmacist is responsible for the development of drug utilization management guidelines, reviewing prior authorizations and medication exception requests. The pharmacist will work as part of a team that is responsible for the review process and clinical determination based on clinical guidelines, and plan benefit design.Position Responsibilities:

  • Reviews prior authorization requests and makes determinations for drug products according to member benefits, coverage criteria, and in compliance with regulatory guidelines.
  • Develops criteria for medication analysis.
  • Develops clinical criteria for review of non-formulary or non-preferred drug list medications.
  • Oversees clinical programs that address drug utilization, efficacy, safety, and related goals.
  • Provides clinical guidance and support to assigned pharmacy technicians.
  • Reviews and develops, as needed, guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design.
  • Evaluates quality controls and implements opportunities for performance improvement in pharmacy practices.
  • Other projects and duties as assigned.
    • Manage multiple, concurrent projects for completion in a thorough and timely fashion.
    • Communicate well both verbally and in writing.
    • Analyze data and regulatory information and formulate sound conclusions and recommendations.Experience & Education:
      • A current, valid, unrestricted California State Pharmacy License and Pharm.D. is required.
      • ASHP-accredited residency in a pharmacy practice or equivalent background/experience required.
      • Minimum 3 years of experience in a clinical pharmacy practice preferred.
      • Current knowledge and expertise in clinical pharmacology and disease states required.
      • Basic working knowledge of managed care or PBM experience preferred.Knowledge of:
        • Current clinical pharmacotherapeutics and disease state management.
        • Managed health care principles and managed health care organizations.
        • Computer software for word processing, spreadsheets, and graphics (Microsoft Office or similar).
        • Oral/visual presentation and marketing techniques for pharmacy programs.Grade:? P#CB

Keywords: CalOptima, Orange , Clinical Pharmacist (Prior Authorizations), Other , Orange, California

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