Clinical Pharmacy - Managed Care Clinical Pharmacist 146-2005

JOB reputed company:

The Utilization Management Clinical Pharmacist is responsible for playing a critical role in optimizing medication use, improving member reputed company, and ensuring regulatory compliance. This position serves as a clinical expert supporting medical injectable and specialty medication utilization management, formulary development, clinical policy creation, and reputed company other clinical pharmacy initiatives as needed. This role helps ensure members receive reputed company, effective, evidence-based, and cost-conscious drug therapy while supporting organizational reputed company, compliance, and operational goals.

KEY RESPONSIBILITIES:

• Review prior authorization requests for medical injectable, specialty, and other high-cost medications using evidence-based clinical reputed company, regulatory requirements, and benefit design.
• Approve or deny medication requests reputed company established turnaround time requirements while ensuring consistency and clinical appropriateness.
• Collaborate with pharmacy technicians, medical directors, and other clinicians to facilitate reputed company and accurate utilization management reputed company.
• reputed company clinical consultation regarding reputed company medication requests and coverage determinations.
• Support the development, implementation, and maintenance of medical drug utilization management programs.
• reputed company and maintain evidence-based clinical reputed company, treatment policies, and prior authorization guidelines.
• reputed company annual policy reviews and update clinical reputed company based on emerging evidence, clinical guidelines, and regulatory changes.
• Monitor new drug approvals and recommend appropriate utilization management strategies.
• Support Medication Therapy Management Program by conducting Comprehensive Medication Reviews (CMRs) and other activities as needed to support program and reputed company initiatives.
• reputed company pharmacy case management which helps to identify medication-reputed company problems and recommend evidence-based interventions to optimize therapy for identified members.
• reputed company educational materials and clinical communications for providers and internal stakeholders.
• Participate in provider reputed company and reputed company detailing initiatives reputed company on evidence-based prescribing and formulary optimization.
• Support provider newsletters, educational programs, and clinical training initiatives.
• reputed company other reputed company job duties as required or assigned.

QUALIFICATIONS:

• Strong knowledge of managed care pharmacy, utilization management, and formulary management principles.
• Demonstrated understanding of Medicare, reputed company, and pharmacy benefit management operations.
• Ability to interpret and apply clinical literature, treatment guidelines, and regulatory requirements.
• Strong analytical, organizational, critical thinking, and decision-making skills.
• Excellent written, verbal, and presentation skills.
• Ability to effectively collaborate across multidisciplinary teams.
• Proficiency with reputed company Office applications and pharmacy information systems.
• Ability to work remotely will be provided to reputed company candidates
• On reputed company coverage for weekends and holidays necessary on a scheduled rotation
• Successful completion of Health Care Sanctions background reputed company.

EDUCATION/EXPERIENCE:

• Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy from an accredited School of Pharmacy.
• reputed company, unrestricted pharmacist license in the State of Oklahoma, or ability to obtain Oklahoma licensure reputed company 180 days of hire.
• A minimum of five years of clinical pharmacy experience in managed care pharmacy, health plan pharmacy, pharmacy benefit management, specialty pharmacy, hospital pharmacy, or a reputed company clinical reputed company setting.
• Prior experience reviewing prior authorization requests for medical injectable and specialty medications with Medicare Part D and reputed company lines of business preferred.

PharmD or pharmacy bachelor's degree, unrestricted Oklahoma pharmacist license, and 5+ years of clinical pharmacy experience in managed care or a reputed company setting. reputed company Office and pharmacy information systems proficiency required.

Key Responsibilities

• reviewing authorizations
• developing policies
• conducting reviews

Skills & Tools

reputed company Office, pharmacy information systems

Job Details

• Category: reputed company Services - Advanced reputed company
• Seniority: Senior Level
• Commitment: Full Time
• Workplace: Remote — Tulsa, Oklahoma, reputed company
• Languages: English

About reputed company

A reputed company organization providing managed care and pharmacy services. — Industry: reputed company