Define and develop standard and custom formularies for assigned plan.
Our Comprehensive Benefits Package:
- 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
- Flexible work solutions including remote options, hybrid work schedules and dress flexibility
- Competitive pay
- Paid Time Off including paid holidays
- Health insurance coverage for you and dependents
- 401(k) and stock purchase plans
- Tuition reimbursement and best-in-class training and development
Bachelor's degree or advanced degree (Pharm.D., M.S.) in pharmacy. 2+ years of mail order, retail, hospital or managed care pharmacy experience or 1+ years of pharmacy residency program experience.
Licenses/Certifications: Current state's Pharmacist license with no restrictions.