Staff Clinical Pharmacist (Tuesday Saturday) Jefferson Health Plan
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Job Location:
Philadelphia, PA - USA
Monthly Salary:
Not Disclosed
Posted on:
4 days ago
Vacancies:
1 Vacancy
Job Summary
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
- 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. BS Pharmacy
- Preferred: 2-3 years clinical pharmacy experience
- Preferred: 1-2 years prior managed care experience
- Excellent written and oral communication skills
- Competency with Microsoft Office Suite including: Word Excel PowerPoint skills and database knowledge
- Self-motivated and team player with ability to direct projects and assignments.
- Strong presentation ability
Work Shift
Workday Day (United States of America)Worker Sub Type
RegularEmployee Entity
Health Partners Plans Inc.Primary Location Address
1101 Market Philadelphia Pennsylvania United States of AmericaNationally 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 65000 people strong dedicated to providing the highest-quality compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrows professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic clinical and applied research. Thomas Jefferson University home of Sidney Kimmel Medical College Jefferson College of Nursing and the Kanbar College of Design Engineering and Commerce dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8300 students. Jefferson Health nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.
Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age race color religion creed sexual orientation gender gender identity marital status pregnancy national origin ancestry citizenship military status veteran status handicap or disability or any other protected group or status.
Benefits
Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues including medical (including prescription) supplemental insurance dental vision life and AD&D insurance short- and long-term disability flexible spending accounts retirement plans tuition assistance as well as voluntary benefits which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues including those who work less than part-time(including per diemcolleagues adjunct faculty and Jeff Temps) have access to medical (including prescription) insurance.
For more benefits information please click here
Required Experience:
Staff IC
Key Skills
About Company
At Thomas Jefferson University in Philadelphia, PA, we are helping you to redefine what’s possible with innovative and tailored education opportunities.
