Job details
Job type full-time
Full job description
Why choose health partners plans?
Health partners plans is an award-winning, not-for-profit health maintenance organization serving more than 280,000 members for more than 30 yearsHealth partners plans has been doing it right and improving health and wellness in communities throughout the greater southeastern pennsylvania region.
Perks of hpp and why you will love it here:
Competitive compensation packages
Flextime and work-at-home options
Generous time off including vacation, sick and personal time
Wellness program
Annual learning stipends
401(k) savings plan with company match and profit sharing
We are hiring a staff clinical pharmacist to join our team remotely!
Working under minimal supervision, the clinical pharmacist is responsible for managing the prescription benefit program for all lines of business for health partnersThe incumbent uses clinical pharmacy expertise as well as approved criteria in administering the prescription prior authorization programOther responsibilities include: suggesting adherence to approved formularies to providers, supporting medical directors in case reviews overseeing the recipient restriction program (rrp), and monitoring appropriate drug utilizationIn addition, incumbents actively participate in physician education & outreach programs, represents the pharmacy department at internal and external committees, and perform claims analysis for drug utilization review (dur) related to fraud, abuse, and over/under-utilization and drug adherence.
As the staff clinical pharmacist, your daily duties may include…
Review prior authorization requests to make coverage determinations to ensure clinical appropriateness based on pharmacy guidelines and established clinical criteria.
Develop and prepare clinical research analysis for pharmacy and therapeutics (p&t) committee presentations.
Educate pharmacy technicians on pharmacy benefit issues both clinical and non-clinical.
Create clinical criteria for new and existing pharmaceuticals following best practices and prepare criteria documents for submission to regulatory agencies.
Respond to pharmacy hotline phone calls from physicians, discussing patient care dosing and safe and effective formulary alternatives, and phone calls from pharmacy providers discussing safe and effective formulary alternatives, processing errors ( i.eEligibility, plans limits exceeded, ndc not covered, refill too soon, etc.) and resolving reimbursement issues.
Gather all necessary clinical (previous medication history) and pharmacoeconomical information including contacting physician or nurse for previous medical history and/or specific required lab tests as deemed appropriate, for presentation to a medical director for prior authorization case review.
Conduct clinical dur on pharmacy claims and make recommendations for recipient restriction program or quality management.
Monitor activities of the existing restricted members.
Assist management in physician, member and pharmacy network dur analysis and other departmental reports.
Interact with other departments including member relations, special needs, complaints and grievances, disease management, and utilization management, in resolving pharmacy related issues along with identify areas of potential operational improvement with other departments.
Assure compliance to all regulatory requirements associated with doh, dpw and ncqa.
Work with external pharmacy vendors ensuring appropriate quality of care and coordination of care.
Research and analyze new pharmaceuticals or new indications for existing pharmaceuticals.
Work within the pharmacy department to create and maintain an updated formulary with appropriate fda safety, quantity and quality edits.
Work with management and the formulary pharmacist on formulary management, utilization review, prior authorization, specialty medication management, pharmacy audit process and other functions within the pharmacy department
Assure compliance with departmental policies and procedures and processes.
Will perform other duties as assigned.
Qualifications and skills:
Required: pharmacy degree from accredited school, pharmDOr bs pharmacy
Preferred: 2-3 years clinical pharmacy experience
Preferred: 1-2 years prior managed care experience
Excellent written and oral communication skills
Competency with microsoft office suite including: word, excel, powerpoint skills and database knowledge
Self-motivated and team player with ability to direct projects and assignments.
Strong presentation ability
Hpp is a nationally recognized company for their innovations in care, health partners plans is more than your average health care company and can help you achieve your career goals!
