Top Health Plan / Managed Care company, is currently seeking a Clinical Pharmacist based out of the Getzville, NY 14068 office. Please apply directly to this posting for consideration.
** This position is WFH (REMOTE)
Pay Rate: $50.00 to $55.00 per hour (determined on experience)
Shift Time: Monday - Friday from 8:30am-5pm EST
- Develop clinical criteria for review of medications, recommend plan design changes and communicate recommendations to clients
- Monitor and review prior authorization requests for medications
- Develop and design clinical edits to adjudicate claims and enhance drug utilization
- Analyze pharmacy cost of care, trends, and coordinate the development of appropriate use protocols and guidelines
- Set criteria for medication analysis, coordinate reports to clients, meet regulatory reporting requirements for drug utilization review and fraud and abuse reporting
- Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
- Participate in the development and implementation of medication therapy management programs
- Provide clinical guidance and support to various departments and address clinical related questions.
- Must be an actively Licensed RPh in New York in good standing
- Must have either a Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy degree
- 2+ years of mail order, retail, hospital or managed care pharmacy experience or 1+ years of pharmacy residency program experience.
- Experience in a Managed Care Pharmacy Setting
- Experience with CVS/Health PBM Systems: RxClaim, CAS, MedHOK
- Be familiar with Centers for Medicare and Medicaid (CMS) regulations and guidelines
- Tru Care Experience
- Medication Therapy Management MTM/CMR experience (preferred not required)
- Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability
- 401k after 1 year of employment: With employer match and profit sharing
- GREAT Hours! Monday through Friday
- Competitive Pay Rate!
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