Managed Care Pharmacy Resident
Core
Operate clinical programs including Prior Authorizations, Medication Therapy Management, Lock-in, and Drug Utilization Review to optimize member care and formulary utilization.
Role type
Managed Care Pharmacy Resident (Clinical/Operational)
Builds
Pharmacy and Therapeutics Committee policies, formulary recommendations, and member care strategies.
Domain
Healthcare / Managed Care Pharmacy
Required skills
Clinical prior authorization, Medication Therapy Management, Drug Utilization Review, Formulary management, Policy review, Claims processing, Appeals resolution
Preferred skills
Managed care experience, Microsoft Office proficiency, Public speaking, Problem-solving
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; Respond to and resolve issues related to member/provider complaints, claims processing issues and appeals.
Seniority
Resident (Entry-level clinical training)