PBM Leveraged Clinical Pharmacist
New
United StatesFull-TimeMiddle
Salary106,300 - 151,800 USD per year
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Job Details
- Experience
- Minimum of 5 years of experience in pharmacy benefit management; Minimum of 3 years of experience supporting a Medicaid PBM account.
- Required Skills
- Data AnalysisMicrosoft OfficePowerPointHIPAA
Requirements
- Doctor of Pharmacy (PharmD) degree.
- Active Pharmacist license.
- Minimum 5 years of experience in pharmacy benefit management.
- Minimum 3 years of experience supporting a Medicaid PBM account.
- Demonstrated knowledge of Medicaid requirements at state and federal levels.
- Working knowledge of HIPAA regulations.
- Proficiency in PowerPoint and experience delivering presentations.
- Strong analytical skills with ability to translate data into practical recommendations.
- Ability to work independently and collaboratively in a team environment.
- Ability to manage competing priorities within tight timelines.
- Proficiency in Microsoft Office and virtual communication platforms.
Responsibilities
- Conduct evidence-based therapeutic class reviews to support PDL management.
- Develop clinical prior authorization recommendations for P&T Committee and DUR Board review.
- Collaborate on the development and maintenance of PA engine rules and question sets.
- Monitor claims data and prescribing patterns to develop retrospective DUR initiatives.
- Contribute to the development of regular Clinical Services publications.
- Provide clinical support for sales pursuits, RFP responses, and product enhancement initiatives.
- Promote cross-functional collaboration across pharmacy business accounts.
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