Managed Care Pharmacy Resident
Core
Operate clinical and operational programs for a managed care pharmacy, including prior authorizations, medication therapy management, and drug utilization review to optimize formulary utilization and member care.
Role type
Managed Care Pharmacy Resident (Licensed Pharmacist)
Builds
Pharmacy care management processes, formulary recommendations, and member/provider support programs
Domain
Healthcare / Managed Care Pharmacy
Deliverable
client delivery
Required skills
PharmD degree, active unrestricted state pharmacy license, clinical prior authorization, medication therapy management, drug utilization review, formulary optimization, therapeutic class reviews, policy review, drug monograph analysis, claims processing, appeals resolution
Preferred skills
Managed care experience, Microsoft Office proficiency, problem-solving, analytical skills, organizational skills, public speaking
Technologies
Microsoft Office (Word, Excel, PowerPoint)
Responsibilities
Complete work related to the Pharmacy and Therapeutics Committee including therapeutic class reviews, policy review, drug monographs, and formulary recommendations; Perform weekly clinical prior authorizations and coverage determinations for Medicaid and Medicare; Participate in the pharmaceutical care management process through reviewing member profiles, recommending members for lock-in, case management or disease management; Respond to and resolve issues related to member/provider complaints, claims processing issues and appeals.
Seniority
Entry-level Resident