Clinical Formulary Pharmacist
Core
Defines and develops standard and custom formularies for Commercial, Medicaid, Medicare Part D, and Health Information Marketplace lines of business.
Role type
Clinical Formulary Pharmacist
Builds
Standard and custom formularies, drug utilization review protocols, and clinical edits for claims adjudication.
Domain
US Healthcare / Pharmacy Benefit Management
Deliverable
production ML models | product features | dashboards & analysis | client delivery
Required skills
Drug use trend analysis, cost of care analysis, regulatory reporting, clinical criteria development, prior authorization review, guideline design, drug information research, P&T committee support
Preferred skills
Prior Authorization process support, Decision Trees testing and interpretation, ComPass system experience, Visio, Excel, Word
Technologies
ComPass, Visio, Excel, Word
Responsibilities
Develop drug product review and formulary recommendations, analyze pharmacy cost of care trends, set criteria for medication analysis, develop clinical edits to adjudicate claims, research drug information for prior authorization reviews, provide clinical guidance to pharmacy technicians
Seniority
Mid-level, hands-on IC