Clinical Pharmacist (Quality)
Core
Define and develop standard and custom formularies, create clinical policies, and apply evidence-based findings to coverage decisions for Medicaid and Medicare plans.
Role type
Senior IC clinical pharmacist (quality & formulary management)
Builds
Clinical policies, formulary decisions, prior authorization criteria, and performance improvement programs for pharmacy/practice
Domain
Healthcare payers (Medicaid/Medicare) + Clinical Pharmacy
Required skills
Data analysis, Microsoft Excel, critical evaluation of clinical trials/treatment guidelines/drug literature, clinical pharmacy background, managed care experience, hospital experience
Preferred skills
Illinois Pharmacist license, pharmacy residency program experience
Technologies
Microsoft Excel
Responsibilities
Develop clinical criteria for medications and recommend plan design changes; Monitor prior authorization requests; Ensure clinical criteria align with state guidelines; Develop and implement programs to impact Drug Utilization Review (DUR) for Medicaid and Medicare; Develop and maintain pharmacy department policies and procedures; Participate in coordination of the Medicare MTM program
Seniority
Mid-Senior level, hands-on IC
