What are the responsibilities and job description for the Clinical Pharmacy Specialist position at Anasazi Medical Payment?
Job Description
Job Description
Description :
The Clinical Pharmacy Specialist will be responsible for evaluating prior authorization requests, interpreting physician chart notes, and collaborating with prescribers and pharmacies to ensure clinically appropriate and cost-effective medication use. This role requires a certified pharmacy technician with strong analytical skills, attention to detail, and the ability to work within established clinical protocols and pharmacy benefit management (PBM) guidelines. Additionally, the Clinical Pharmacy Specialist will contribute to optimizing clinical pharmacy processes and procedures to enhance efficiency and improve patient and business outcomes.
Essential Responsibilities :
1. Prior Authorization Review
o Process and evaluate prior authorization requests using established protocols and guidelines.
o Verify supporting documentation such as physician notes, lab results, and medication histories.
o Accurately document determinations and communicate decisions to prescribers, pharmacies, and other stakeholders.
2. Collaboration and Communication
o Work with prescribers and pharmacies to address missing information, clarify treatment plans, or resolve issues related to medication requests.
o Provide updates to internal teams, including clinical pharmacists, client services, and operations, as needed.
3. Protocol and Formulary Support
o Assist with the maintenance and application of prior authorization and step therapy protocols.
o Support the clinical team in managing formulary updates and identifying opportunities to enhance utilization management strategies.
4. Documentation and Reporting
o Maintain accurate and complete records of prior authorization activities and outcomes.
o Prepare reports summarizing trends in prior authorization requests and identifying areas for improvement.
o Help in development of prior authorization letter and note templates.
5. Regulatory Compliance
o Ensure adherence to all applicable laws and regulations, including HIPAA, PPACA, and state-specific requirements.
o Stay informed about updates to pharmacy regulations and industry standards.
6. Additional Responsibilities
o Support cross-functional projects, such as client implementations and training initiatives.
o Participate in quality assurance and continuous improvement efforts to optimize workflows.
Perform other duties as assigned by the Clinical Pharmacy Director or leadership team.
Requirements : Skills / Abilities :
- Excellent verbal and written communication skills
- Strong understanding of the PBM industry required.
- Strong data management experience and skill preferred.
- Healthcare, health plan, ERISA self-funded employer, and TPA experience preferred.
- Excellent customer service skills
- Strong analytical and problem-solving skills
- Detail oriented, flexible, and strong organizational skills
- Ability to work independently and within a team environment.
Education / Experience :
