Senior Clinical Pharmacist
Core
Define and develop standard and custom formularies for complex or specialized medications; monitor prior authorization requests; analyze pharmacy cost of care and trends; implement medication therapy management programs.
Role type
Senior Clinical Pharmacist (Managed Care/Pharmacy Benefit Management)
Builds
Standard and custom formularies, clinical edits, medication therapy management programs, utilization review protocols
Domain
Healthcare, Pharmacy Benefit Management, Managed Care
Required skills
Formulary design, clinical criteria development, prior authorization review, claims adjudication, cost of care analysis, medication therapy management, regulatory reporting, drug utilization review, program performance evaluation, strategic relationship building
Preferred skills
Advanced degree (Pharm.D., M.S.), pharmacy residency experience, experience with Commercial/Medicaid/Medicare Part D programs
Technologies
Pharmacy management systems, claims adjudication platforms, data analysis tools
Responsibilities
Develop clinical criteria for complex medication reviews, monitor and review prior authorization/appeal requests, analyze pharmacy cost of care and trends, implement medication therapy management programs, ensure quality controls and performance improvement, research drug information for prior authorization reviews, provide clinical guidance to departments, maintain regulator-required formularies and edits, support clinical program outcome analysis across patient populations
Seniority
Senior, hands-on IC