Job Description
We are aggressively seeking a Clinical Pharmacist to join a large Healthcare organization. As the year 2017 is in full swing, this organization is very busy, and they need YOUR help.
Take advantage of flexible hours, a competitive salary, and be a Clinical Pharmacist with one of the fastest-growing healthcare companies in U.S. Get in NOW, while there is still huge room for growth and career development!
This exciting opportunity will require an Clinical Pharmacist who can provide a high level of service and attention to their patients. If you are a Clinical Pharmacist and you meet the qualifications listed below, please click apply below for consideration
Daily Responsibilities:
The Clinical Pharmacist provides timely drug therapy for Medicaid health plan members by processing prior authorization and medical necessity requests for specialty medications.
- Review specialty medication prior authorization requests (i.e. biopharmaceuticals) according to established treatment protocols, clinical criteria and member benefits. and make coverage determinations within the defined turnaround times and meet regulatory requirements
- Responsible for clinical criteria for specialty medications including analysis, monitoring of industry trends and develop criteria recommendations for Pharmacy and Therapeutics Committee and clients
- Define and coordinate prior authorization and drug utilization reviews reports for clients and ensure regulatory reporting requirements for drug utilization review and fraud and abuse reporting are met
- Oversee the drug utilization review and medication therapy management programs for specialty medications at the assigned plan to meet regulatory requirements and develop systematic reviews of prescription claims to meet strategic initiatives
- Develop and design specialty medication clinical edits for claims adjudication and enhanced drug utilization review
- Provide clinical guidance, support and oversight to the assigned Pharmacy Technicians
- Develop and review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design
- Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practice specific to specialty pharmacy
- Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization review
Qualifications
Requirements:
- Bachelors or advanced degree in pharmacy
- 5+ years of recent specialty, Pharmacy Benefits Management (PBM) or Managed Care experience
- Knowledge in Med D and Prior Authorizations or Pre-certifications
- Knowledge in Insurance experience (Medicare, Medicaid, commercial)
- Computer skills are a MUST (MS Excel, Word, Outlook)
Additional Information
Advantages of this Opportunity:
- Competitive salary: Up to $ 58.00 per hour (depending on license and experience)
- 40 hours per week: Can be anywhere between, 8:00 AM - 9:00 PM
- Start date: As soon as possible
- Long Term Contract to Permanent
- Growth Opportunity
- Fun and positive work environment
Interested in being considered?
If you are interested in being considered for the Clinical Pharmacist position, please click the I'm Interested button below to be qualified for this fast-moving opportunity!
Company Description
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!