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Clinical Staff Pharmacist

Pharmpix Guaynabo, PR

  • Expired: over a month ago. Applications are no longer accepted.
Job Description

POSITION SUMMARY

This position reports to the Clinical Director. The Clinical Staff Pharmacist is the primary staff clinician and drug information specialist for the Clinical Programs, Utilization Management, and Formulary Units within the Clinical Department. The Clinical Pharmacist is responsible for preparing clinical reports and drug monographs, as well as preparing and presenting information to the various boards (i.e. DUR Board) and committees (i.e. Pharmacy & Therapeutics (P&T) Committee). The Clinical Pharmacist also assists data analysts by providing clinical criteria for reporting.

 

ESSENTIALS ROLES AND RESPONSIBILITIES

  1. Actively support the Clinical Programs Manager, the Utilization Management Manager, and the Formulary Manager in a “floater pharmacist” capacity, meeting departmental needs across all three sections as needs fluctuate. Spend about 20% of work hours in each of the three departments monthly, 20% of work hours providing drug information request feedback, and 20% of work hours on miscellaneous tasks.
  1. Serve as the primary drug information specialist, meaning the pharmacist in this position will research and provide feedback on all drug information requests (approximately 20%).
  1. Assist in Utilization Management Unit oversight (approximately 20%).
  1. Make medical necessity and benefit decision determinations.
  2. Make decisions per established pharmacy guidelines, contract criteria, industry regulations, and sound clinical judgment.
  3. Work independently concerning reviews and decision making, with the support of senior pharmacist staff and supervisors.
  4. Work as a member of a team of peers committed to meeting or exceeding quality standards and customer performance guarantees.
  5. Telephonically provide clinical support to the PharmPix Clinical Call Center.
  6. Engage providers in discussions to support determinations.
  7. Support Fraud and Abuse program system oversight.
  8. Participate in various Pharmacy-related projects.
  9. Keep abreast of industry trends and regulatory changes.
  10. Keep abreast of operational directives and customer reference materials.
  1. Assist in Formulary Unit oversight (approximately 20%).
  1. Support the creation and maintenance of all formularies including the evaluation of all aspects of the formulary utilization management program (PA, ST, Quantity Limit, cDUR, rDUR, etc.). 
  2. Support the annual review of Formulary unit standards, such as quantity limit and step therapy protocols. 
  3. Provide timely responses related to formulary management inquiries made by clients, providers, brokers, and/or the PharmPix team. 
    1. Develop drug product review and formulary recommendations by assessing drug use trends, new drug releases, and primary literature review.
    2. Analyze pharmacy cost of care, trends, and coordinate the development of appropriate use protocols and guidelines.
    3. Set criteria for medication analysis, coordinate reports to clients, and meet regulatory reporting requirements for drug utilization review and fraud and abuse reporting.
    4. Support the development of clinical criteria for review of non-formulary or non-preferred drug lists medications and communicate recommendations to clients.
    5. Support the development and design of clinical edits to adjudicate claims and enhance drug utilization.
    6. Research drug information to maintain drug knowledge and disease state understanding for application to utilization management.
  1. Assist in Clinical Programs Unit oversight (approximately 20%).
    1. Support the P&T Committee Pharmacist in: 
  1. FDA-approvals monitoring
  2. PharmNotes preparation
  3. Monographs preparation
  4. Development of prior authorization criteria 
  5. Presentations to P&T Committee
    1. Support the Clinical Programs Manager in: 
  1. FDA-safety issues monitoring 
  2. Preparing educational materials for members, clients, and/or pharmacies (i.e. drag safety issues, including drug recalls, notifications, newsletters, etc.)
  3. Periodic review of prior authorization criteria, including form updates as needed.
  4. Updating the information and documentation list for the Call Center and Specialty List.
    1. Contribute to URAC Accreditation of Clinical Quality Programs initiatives.
  1. Support the annual review of Policies and Procedures (including SOP- Standard Operating Procedures) of all Clinical Units. 
  2. Provide timely responses related to utilization management inquiries made by clients, providers, brokers, and/or the PharmPix team. 
  1. Research drug information to maintain drug knowledge and disease state understanding for application to utilization management.
  1. Generate, review, and analyze reports as requested by Clinical Director/clients or other company departments (example audits department, Formulary reports, Scorecards). 
  2. Support preparation of educational materials for members, clients, and pharmacies.
  3. Participate in the development and implementation of initiatives to improve processes and procedures. 
  4. Maintain professional affiliations and certifications. Enhance professional development to keep current in the latest healthcare trends and developments. 
  5. Support all Quality Management Program initiatives. 
  6. Support Pharmacy Monthly Meetings. 
  1. Attend all P&T meetings.
  1. Other projects and duties as assigned. 


TRAINING & EDUCATION 

  • B.S. in Pharmacy or PharmD. 
  • Academy of Managed Care Pharmacy (AMCP) Managed Care Certification or certification within the first six months of employment. 

 

LICENSURE/CERTIFICATION

  • Current, valid, and unrestricted state or Puerto Rico Pharmacist license.
  • Active membership in a state or PR pharmacy association. 

 

PROFESSIONAL EXPERIENCE

  • Pharmacy benefit manager pharmacy residency program (preferred).

 

PROFESSIONAL COMPETENCIES

Knowledge:

  • A thorough understanding of the managed care industries from the perspective of Pharmacy Benefit Managers and providers of care. 
  • Knowledge of the Puerto Rico managed care market (preferred).
  • Knowledge of the community’s health systems’ purposes, organization, and policies enough to interact with other health care providers. 
  • Knowledge of federal health care delivery and pharmacy regulations/regulatory agencies. 
  • Knowledge of the Commonwealth of Puerto Rico health care delivery and pharmacy regulations/regulatory agencies (preferred). 
  • Comprehension of Medicare Part D rules and regulations. 
  • Knowledge of the rules and regulations promulgated by the US Congress related to pharmacy benefits, especially the Medicare Modernization Act of 2003. 
  • Knowledge of financial aspects of managed care contracts, financial data, and compliance. 
  • Knowledge of Microsoft applications.

Skills:

  • Skill in exercising a high degree of initiative, judgment, discretion, and decision-making to achieve organizational objectives. 
  • Demonstrated effective organizational and communication skills. 
  • Skills in negotiations and diplomacy. 
  • Skill in exercising judgment in applying, interpreting, and coordinating departmental policies and procedures. 
  • Strong problem analysis and decision-making skills. 
  • Strong analytical skills.

Abilities:

  • A demonstrated ability to establish and maintain quality control standards.
  • Ability to engender a team spirit at all levels of the organization.
  • Ability to organize and integrate organizational priorities and deadlines.
  • Ability to work independently or as part of a team. 
  • Ability to develop and maintain productive relationships with other internal departments, PharmPix clients, and other health care professionals. 
  • Ability to manage people and provide team leadership. 
  • Demonstrated ability to manage a staff conducting a wide variety of functions. 
  • Fully bilingual English and Spanish (preferred). 


PharmPix is an Equal Employment Opportunity Employer Minorities / Females / Disable / Veterans

Pharmpix

Address

Guaynabo, PR
00968 USA

Industry

Healthcare

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