Staff Clinical Pharmacist, Part Time - Jefferson Health Plan

Job Details

Working under minimal supervision, the Clinical Pharmacist is responsible for managing the prescription benefit program for all lines of business for Health Partners. The incumbent uses clinical pharmacy expertise as well as approved criteria in administering the prescription prior authorization program. Other responsibilities include: suggesting adherence to approved formularies to providers, supporting Medical Directors in case reviews overseeing the recipient restriction program (RRP) and monitoring appropriate drug utilization. Incumbents actively participate in physician education & outreach programs, represents the pharmacy department at internal and external committees and perform claims analysis for drug utilization review (DUR), related to fraud, abuse, and/or over/under-utilization and drug adherence.

Job Description

Please note this is a part time role, currently scheduled for 20 hours/week

• Able to work in a constant state of alertness and safe manner
• Review prior authorization requests to make coverage determinations to ensure clinical appropriateness based on pharmacy guidelines and established clinical criteria.
• Develop and prepare clinical research analysis for Pharmacy and Therapeutics (P&T) committee presentations.
• Educate and support Pharmacy Technicians on pharmacy benefit issues both clinical and non-clinical.
• Create clinical criteria for new and existing pharmaceuticals following best practices and prepare criteria documents for submission to regulatory agencies.
• Respond to pharmacy hotline phone calls from physicians, discussing patient care dosing and safe and effective formulary alternatives, and phone calls from pharmacy providers discussing safe and effective formulary alternatives, processing errors (i.e., eligibility, plans limits exceeded, NDC not covered, refill too soon, etc.) and resolving reimbursement issues.
• Gather all necessary clinical (previous medication history) and pharmacoeconomically information including contacting physician or nurse for previous medical history and/or specific required lab tests as deemed appropriate, for presentation to a Medical Director for prior authorization case review.
• Conduct clinical DUR on pharmacy claims and make recommendations for recipient restriction program or quality management.
• Monitor activities of the existing restricted members.
• Assist management in physician, member and pharmacy network DUR analysis and other departmental reports.
• Interact with other departments including Member Relations, Special Needs, Complaints and Grievances, Disease Management, and Utilization Management, in resolving pharmacy related issues along with identify areas of potential operational improvement with other departments.
• Assure compliance to all regulatory requirements associated with DOH, DPW and NCQA.
• Work with external pharmacy vendors ensuring appropriate quality of care and coordination of care.
• Research and analyze new pharmaceuticals or new indications for existing pharmaceuticals.
• Work within the Pharmacy Department to create and maintain an updated formulary with appropriate FDA safety, quantity, and quality edits.
• Work with management and the formulary pharmacist on formulary management, utilization review, prior authorization, Specialty Medication management, pharmacy audit process and other functions within the pharmacy department
• Assure compliance with departmental policies and procedures and processes.
• Will perform other duties as assigned.

Education and Experience:

• Required: Pharmacy degree from accredited school, Pharm. D., R.Ph,or BS Pharmacy
• Preferred: 2-3 years clinical pharmacy experience
• Preferred: 1-2 years prior managed care experience

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research.