Position would be focused on supporting the prior authorization program. Currently this is a remote position.
This position is accountable for supporting Pharmacy clinical management. The responsibilities include assisting in formulary management, medication therapy management, utilization management, research and collaboration with disease management and medical management.
- Supports the timely review of Pharmacy appeals
- Supports the pharmacy lock-in program including profile review and presentation
- Coordinates projects with activities performed by other clinical Pharmacists for the residents and students.
- Support the Drug Utilization review program
- On call responsibility as required.
- Supports clinical programs both internally and externally
- Assist in managing and training Pharmacy techs for Medication therapy management
- Supports the Utilization management program
- Supports prior authorization program by handling prior authorization requests from Pharmacies and physicians through existing policies and procedures.
- Supports the pharmacy formulary management program, medication therapy management program, and related P&T committee activities
- Interfaces with medical directors, and other areas for Pharmacy related initiatives
- Responsible for member interface through comprehensive medication review for Medicare beneficiaries
- Responsible for Medicare beneficiaries pharmacy management program, understand the mandates and follow the guidelines
- Assists with the internal drug information services.
- Reviews and analyze reports on utilization management, and evaluates business needs for data analysis.
- Manage and update formulary communications.
- Participates in the Pharmacy Case Management Program.
- Maintains and reports relevant drug pipeline/patent loss detail to medical team
- Assists in the creation of member and provider newsletters
- Prefers up to one to two year experience in managed care.
- Requires a bachelor's of science degree in pharmacy from an accredited college or university.
- Prefers a Pharm D from an accredited college or university.
- Requires retail, or other pharmacy experience.
- Requires an active Registered Pharmacist license in New Jersey.