What are the responsibilities and job description for the CLINICAL PHARMACIST position at UHS?
The Clinical Pharmacy Coordinator executes clinical programs related to utilization management, care management, and quality improvement. To do this, this position will have knowledge of pharmaceutical services provided under both the pharmacy and medical benefits. The Clinical Pharmacist Coordinator will be responsible for pharmaceutical service request reviews and render determinations of medical necessity and appropriateness of request.
The Clinical Pharmacy Coordinator holds an active, unrestricted license or certification to practice pharmacology medicine in a state or territory of the United States. They are qualified to render appeal determinations in addition to initial determinations and non-certifications. The Clinical Pharmacy Coordinator Reviewers have access to consult with initial clinical reviewers, other medical advisors, licensed doctors, or peer reviewers through several modes of contact. The position will regularly interface with the pharmacy benefits manager, pharmacies, provider offices, members, brokers, and employer groups. This position will also assist with compliance and business development activities. The Clinical Pharmacy Coordinator assists in maintaining and updating clinical policies relevant to drug utilization management.
The Clinical Pharmacy Coordinator will also support the Prominence DSNP Model of Care by reviewing medications for members on that plan and communicating with prescribers to assure medications are not duplicative, interactive, and appropriately dosed for the elderly as part of an Interdisciplinary Care Team.
Qualifications
Required:
- Pharm.D. or BS Pharmacy
- Active/Current Pharmacist licensure in good standing
- Experience applying clinical criteria in prior authorization review setting
Preferred:
- 2 years of previous health plan experience, including Medicare Advantage
- Written and verbal Spanish language proficiency
Specialized subject matter expertise in one or more of the following topics required:
- Home infusion pharmacy operations
- Commercial HMO/PPO/POS
- Medicare Part D
- Mail Service/Specialty pharmacy
- Pharmaceutical benefit design
- Oncology treatment guidelines
- Other facets of pharmaceutical, managed care, and PBM industries
