Job Description

General Purpose of Job:

This position is responsible for ensuring appropriate medication utilization by working with providers and members in the areas of education and case management. This position is also responsible for pharmacy benefit determinations, and assisting with formulary development and maintenance through the P&T committee.

Essential Duties:

This job description is intended to cover the minimum essential duties assigned on a regular basis. Associates may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position.

• Participate in the daily workflow operations, including clinical benefit determination of drugs requiring prior authorization.
• Provide support and education and clinical services to internal departments and affiliates regarding the pharmacy prior authorization process, to include medication therapy management program
• Assist in monitoring medication use and corresponding cost patterns
• Create summary monograph report for Pharmacy and Therapeutics (P&T) committee on new medications to market to include pharmacoeconomic cost-benefit data
• Serve as back-up contact person for PBM vendor regarding clinical issues
• Assist in clinical programs and participate in inter-departmental clinical meetings
• Research, audit current utilization, and create reports detailing price fluctuations of current medications on formulary and provide clinical recommendations to P&T

Job Requirements

General Requirements	* Demonstrates knowledge and maintains and respects patient right to privacy by following the HIPAA Privacy and Security policies and procedures. * Adheres to ICARE values and standards of behavior (Innovation, Compassion, Accountability, Respect, Excellence). * Role model behaviors that value the diversity of our associates, patients and customers and supports creating an environment that is inclusive, welcoming and respectful. * Communicates with patients, families and customers using AIDET (Acknowledge, Introduce, Duration, Explanation, Thank). * Works in a safe manner and promptly reports any hazards identified in the work environment or related to assigned responsibilities.
Work Experience	* Advanced clinical degree and/or clinical experience including therapeutic drug monitoring. * Minimum of 3 years of work in a pharmacy environment. * Experience working directly with a health plan or a pharmacy benefit manager preferred
Education	Graduate of an accredited College of Pharmacy. Doctor of Pharmacy Degree (Pharm D) HR preferred
Specialized Knowledge and Skills	Ability to effectively communicate with other Health Plan employees, members and their families, and providers in the community. Demonstrated knowledge of word processing and spreadsheet software programs. Clinical evaluation skills necessary to suggest cost effective therapy while maintaining quality care. Demonstrated leadership, planning, communication and evaluation skills.