Clinical Pharmacist

US-RI-Smithfield
Req No.
2017-8110
Department
Pharmacy
Type
Regular Full-Time
Category
Medical/Health

Overview

This position works in conjunction with the Pharmacy Operations and Medical Management staff to review medication utilization and develop/implement initiatives to ensure appropriate drug therapy prior authorization decisions are consistent with covered benefits, quality of care and medical necessity. Work is focused at both the individual patient and “population based” therapy level. In addition, he/she supports the department by coordinating the activities of the Pharmacy Operations Manager and formulary advisory committees. He/she may also participate in care management activities and provide backup coverage to the Pharmacy Operations Manager as needed.

Responsibilities

  • Researches drug literature and drug utilization data and developments clinical monographs use by the Pharmacy & Therapeutic (P+T) Committee.  Prepares and presents documents for P+T Committee review.  Provides follow up on all recommendations made by the P+T Committee and/or Chief Medical Officer.
  • Conducts retrospective DUR on patients with complex and/or expensive drug regimens or patients with specific disease states. Provides follow up with patient, Provider and/or referral to Case Management staff.
  • Reviews Prior Authorization (PA) Requests submitted by Providers.  Uses clinical expertise and independent judgment to evaluate PA to determine if request meets established Clinical Medical Necessity (CNM) criteria.  Engages ordering Provides in discussion related to CNM.  Approves PA requests as appropriate. Makes clinical recommendation to deny PA requests as appropriate (refers recommendation for denial to Physician Reviewer). Documents all aspects of PA review process within PA software application (PerformPA)
  • Assists in the development and implementation of specific “non-formulary” to “formulary” conversion initiatives
  • Conducts one-on-one counseling sessions (e.g. “Brown Bag” type programs) with patients related to drug therapy management
  • Conducts academic detailing sessions and other outreach activities directed at providers. Includes meetings at high volume Provider locations.
  • Manages initiatives and pharmacy decisions (e.g. COB initiative, ½ tablets, generic alternatives, therapy step edits, PA’s, dermatology specialty edits)
  • Supports Case Management staff by participating in patient discharge planning associated with drug therapy. Develops educational and information materials to be used in the discharge planning process. Counsels (via telephone) patients who are discharged from the hospital
  • Attends and participates in appropriate in-house meetings
  • Other duties as assigned
  • Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies, and procedures as it applies to individual job duties, the department, and  the Company. This position must exercise due diligence to prevent, detect, and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates, and/or agents.

Qualifications

Required:

  • Registered Pharmacist – eligible for a license in the state of Rhode Island
  • Bachelor’s Degree in related field and/or PharmD
  • One (1) year experience as Pharmacist preferred
  • Strong analytical skills
  • Strong clinical skills
  • Ability to resolve issues and complete required duties with little supervision
  • Good verbal and written communication skills including presentation skills
  • Intermediate to Advanced skills in Microsoft Office (Word, Excel, Outlook)
  • Flexibility in work schedule


Preferred:

  • Managed Care experience

Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.

 

Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at recruiting@nhpri.org

 

Neighborhood is an EOE M/F/D/V and an E-Verify Employer

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