Staff Rx Clinical Programs Pharmacist (Pharmacy Claims, Audit and Review)

Description

The Staff Rx Clinical Programs Pharmacist develops and integrates programs developed to improve overall health outcomes with a focus on prescription drugs. The Staff Rx Clinical Programs Pharmacist work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Staff Rx Clinical Programs Pharmacist oversees medication therapy, strategy on comprehensive medication reviews, and ensures prescription drug optimization in cases where patients are taking multiple opioid medications. The Staff Rx Clinical Pharmacist will be responsible for independently completing timely reviews and decisions of case files for patients obtaining controlled substances, including but not limited to calculating daily morphine milligram equivalent (MME) of current opioid regimen. Will convey passion for assisting prescribers and pharmacists to treat patients who have chronic pain, opioid use disorder (OUD), substance use disorder (SUD) diagnoses. Conducts telephonic outreach to providers to discuss therapy regimens and/or concerns, and completes appropriate written documentation of outreach. Communicates with other team members and/or other departments when issues are identified. Maintains knowledge of emerging drugs of abuse and legislative actions that will impact the Drug Management Program. Participates in meetings as required. Completes additional projects as assigned. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

• May require on call evening/weekend rotation to meet business needs.
• This position can be worked remotely

The Staff Clinical Pharmacist is a clinical pharmacist that works in Humana's Drug Management Program, which conducts case management on potential at-risk beneficiaries and at-risk beneficiaries, as defined by CMS, or other beneficiaries in additional projects as determined by business needs.

Required Qualifications

• Bachelor of Science in Pharmacy or PharmD Degree from an accredited college of pharmacy
• Active pharmacist license in good standing, in the state(s) in which you are required to practice
• Ability to participate in Federal prescription programs
• 3+ years of experience as pharmacist
• Excellent written and verbal communication skills
• Ability to perform mathematical analysis
• Strong organizational skills and ability to stay on schedule
• Work ethic that is focused, accurate, and highly productive
• Ability to work independently and within a team setting to achieve goals and meet deadlines.
• Ability to solve problems and encourage others in collaborative problem solving
• Basic knowledge of Microsoft Office applications, and strong Excel skills

Preferred Qualifications

• Previous experience with medication, prescriber or pharmacy lock-in
• Experience in case management of controlled substances or other drugs of abuse
• Completion of pharmacy practice residency and/or board certification
• Managed care experience

Additional Information

• Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10-panel drug test

Scheduled Weekly Hours

40