Pharmacist - Pharmacy Benefit Management in Remote at Remote
Job Description
Formulary management including but not limited to activities such as adjudication, formulary decision making, and benefit determination.
Respond to and resolve clinical inquiries from members, clients, providers, or pharmacies related to formulary options, therapeutic alternatives, and coverage determinations.
Oversee completion of prior authorization requests for members through collaboration with PBM Pharmacy Technicians.
Coordinate with pharmacy claims processor to ensure formularies, clinical edits, and plan designs are implemented according to requirements.
- Assist with developing and presenting drug monographs, executive summaries, therapeutic class reviews, and medication policies to Pharmacy & Therapeutics Committees.
Utilize claims data to evaluate benefit design for inappropriate utilization and opportunities to improve outcomes and optimize drug spend.
Responsibilities
Job Related Knowledge, Skills and Abilities (Competencies):
- Drug therapy knowledge (Dosage, indications, side effects, etc.)
- Contemporary medication use systems
- Drug information through written and verbal consults as well as monographs
- Interpersonal communication
- Excellent organizational skills
- Supervisory concepts (for indirect reports)
- Problem solving
- PBM operational experience
- Specialty pharmacy practice
- Pharmacy benefit design
- Pharmacy & Therapeutics Committee participation
- Medication policy development
- Pipeline development
- Project management skills
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