Rebate Processing Jobs in Ohio (NOW HIRING)

Position Summary

Pharmacist assists in the management of performance for all pharmacy lines of business. The Clinical Pharmacist involves collaborating with multi-disciplinary teams, utilization management, and adhering to organizational and regulatory policies and procedures.

Department Summary

The primary purpose of the Clinical Pharmacist is tasked with providing operational support for evaluating, implementing, and maintaining the commercial and marketplace pharmacy formularies and utilization management. The Clinical Pharmacist will develop strategies to apply the appropriate formulary placement and UM tools for both medical and pharmacy drugs. The Clinical Pharmacist will monitor FDA approvals, drug manufacturer pipelines, and evaluate drug utilization reports to apply to the AultCare formularies. The Clinical Pharmacist will write drug monographs for Pharmacy and Therapeutics committee review. The Clinical Pharmacist will also be responsible for the daily activities of the pharmacy program, including the clinical decision-making process of coverage determinations.

Qualifications

• Bachelor of Science or Doctor of Pharmacy (Pharm.D.) with Active and unrestricted pharmacist license in the State of Ohio.

• Residency/fellowship preferred.

• 2-3 years experience with a health plan or PBM, preferred.

Department Qualifications

• Knowledge of formulary development and maintenance processes.

• Understanding of highly managed specialty medications/strategies.

• Familiarity with rebate and financial implications of formulary strategies.

• Experience with large datasets preferred.

Skills

• Ability to independently identify, research, and resolve issues.

• Capacity to balance multiple complex projects simultaneously.

• Exceptional written and verbal communication skills.

• Highly flexible, well-organized, and able to adapt priorities easily.

• Strong attention to detail and commitment to delivering high-quality work products.

• Proficiency in Microsoft Office Suite, particularly Microsoft Excel.

Department Skills

Responsibilities & Expectations

• Translate clinical information into functional specifications within a clinical rule set to be implemented at pharmacy point-of-care programs, including formulary development, medication compliance, prior authorization, step therapy, adherence, drug utilization review, dose optimization, and reviewing prescriber patterns.

• Oversee aspects of the pharmacy rebate and pharmacy network program.

• Collaborate with the Part D clinical pharmacist, medical management programs, operational, and customer service departments.

• Implement legislative updates.

• Manage the Medication Therapy Management program.

• Continuously review, recommend, and implement process improvements as needed or directed.

• Analyze data and provide outcomes to the team and clients.

• Uphold professional standards to enhance departmental development.

• Practice ethical conduct.

• Support formulary administration audits with Compliance or other applicable organizations.

• Lead formulary change processes within URAC/NCQA/CMS guidelines.

• Participate in the Pharmacy and Therapeutics (P&T) Committee as an ad hoc member.

Department Responsibilities & Expectations

• Work closely with the Part D and Commercial Clinical Pharmacist teams, medical management programs, and operational and customer service departments.

• Collaborate with leadership to manage operational aspects of commercial product lines, including organizing and maintaining workflow, driving process improvements, and supporting employee education initiatives.

• Facilitate cross-functional communication between departments and teams to drive clinical and quality initiatives aimed at improving health outcomes and performance metrics.

• Analyze operational data and metrics to identify trends and recommend improvements.

Working Conditions

• Hybrid schedule available depending on the staffing needs of the department.

• Extended hours, weekends, and holidays consistent with industry demands.

Hazardous Exposure Category

Category III - Includes tasks that involve no exposure to blood, body fluids, or tissues and Category I tasks are not a condition of employment. The normal work routine involves no exposure to blood; body fluids or tissues (although situations can be imagined or hypothesized under which anyone anywhere might encounter potential exposure to body fluids.) Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency care or first aid or to be potentially exposed in some other way.