Clinical Pharmacist

The Clinical Pharmacist is a dynamic position responsible for the review of prior authorization requests for medications requested under the medical benefit. Additionally, the Clinical Pharmacist will be responsible for developing clinical criteria, medical policies for provider administered medications, review of monthly report for quality assurance, and staying current with literature, evidence-based medicine, and trends in medicine. The Clinical Pharmacist will work directly with prescribing physicians and Medical Directors to discuss clinical rationale for review decisions. This position reports to the Director of Pharmacy.

Duties & Responsibilities:

• Monitor and review prior authorization requests for medications
• Calculate appropriate billable units based on dosing based, indication, weight, BMI and other clinical considerations
• Develop clinical criteria and medical policies for the review of medications
• Ensure all clinical criteria is in compliance with Center of Medicare and Medicaid Services (CMS) and the New York State Department of Health (NYSDOH)
• Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
• Ensure prior authorization reviews are conducted in timeframes set forth by CMS and/or NYSDOH
• Review monthly reports and provide feedback on trends, ideas for efficiency, and innovation
• Ability to work well in a team environment and be a team player
• Additional duties as assigned 

Minimum Qualifications:  

• Pharmacy degree from an accredited school of pharmacy
• Registered Pharmacist in the state of New York with a license in good standing.
• Minimum of 1 year experience conducting prior authorization reviews
• Strong clinical knowledge of pharmaceuticals and disease states in order to conduct prior authorization reviews
• Strong clinical writing and verbal skills
• Demonstrated critical thinking and problem-solving skills.
• Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefits
• Passion for learning, promoting the profession of pharmacy, and interest in growing skills in a dynamic environment with various opportunities

Preferred Qualifications: 

• PGY1 Managed Care Residency (optional)
• Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local Coverage Determinations.
• Ability to lead large and small working meetings.
• PC Skills with Microsoft Outlook, Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables).

License or Certification: Licensed pharmacist in the state of NY in good standing.

Regulatory or Compliance activities: 

Assists in regulatory and compliance audits for all plans. Ensure all activities are conducted in compliance with regulations.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER.  HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services,  LLC.