Job Description
Position Overview:
Are you ready to make a difference in the lives of millions of individuals? Join a dedicated team focused on improving healthcare outcomes for Medicaid members as a Clinical Pharmacist. This fully remote position is based in Hawaii, and you'll have the flexibility to work from home while playing a key role in managing drug therapy for members of a Medicaid health plan. As a Clinical Pharmacist, you'll make important decisions about drug utilization, manage prior authorization requests, and contribute to health plan initiatives that help ensure our members receive the best care possible.
Key Responsibilities:
Review and assess prior authorization requests, making informed determinations on drug products based on member benefits and coverage criteria.
Develop and implement criteria for medication analysis, ensuring adherence to regulatory requirements for drug utilization reviews, fraud, and abuse reporting.
Create and recommend clinical criteria for non-formulary and non-preferred medications, providing expert guidance to clients.
Oversee the drug utilization review and medication therapy management programs, ensuring compliance with Medicare Part D and contributing to strategic initiatives.
Develop and implement clinical edits to improve drug utilization at the point of sale, using evidence-based practices.
Offer support and clinical guidance to pharmacy technicians, ensuring high-quality work and continuous learning.
Review and develop guidelines for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committees and pharmacy benefit design.
Evaluate pharmacy practices and implement opportunities for performance improvement to ensure quality control and optimal member outcomes.
Stay up to date on drug information and disease state knowledge to maintain clinical expertise for prior authorization reviews.
Perform other duties as assigned and adhere to company policies and standards.
Qualifications:
A Bachelor's degree or advanced degree (PharmD, M.S.) in pharmacy.
At least 3 years of experience in retail or hospital pharmacy, or 1 year of experience in managed care pharmacy.
Clinical pharmacy experience in managed healthcare is preferred.
Active, unrestricted Pharmacist license in Hawaii (additional state licenses may be required based on location or contractual needs).
Preferred Qualifications:
Comfortable using various technologies or willing to learn new systems.
Familiarity with Hawaii health plan rules and regulations.
Experience in Prior Authorization and Utilization Management, specifically in pharmacy and medical pharmacy.
Ability to thrive under pressure in a small team environment, serving as the go-to person for many requests.
Compensation:
The annual salary range for this position is $103,500 - $191,600, depending on experience and qualifications.
If you're looking for an opportunity to apply your pharmacy expertise while making a meaningful impact in healthcare, we'd love to hear from you!
Employment Type: Full-Time
Salary: $ 103,500.00 191,600.00 Per Year
Job Tags
Full time, Remote job, Work from home,