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Clinical Pharmacist

Rego Park, New York Apply Now Job ID 1165562 Additional Locations US,New York;Getzville,US,New York;Fairport Category Pharmacy Organization Fidelis Care Schedule Full-time
Description:

Position Purpose: Define and develop standard and custom formularies for assigned plan.


Primary responsibilities:
•    Conduct provider outreach for regimens in question in addition to reminders on QARR-centric goals, such as routine office visits, viral load testing, and syphilis testing
•    Provide reminders to providers and members for routine office check-ups, viral load testing, and syphilis screening through opportunities made upon prior authorization requests, medication therapy management reviews, and drug utilization reviews; this will be done in collaboration with Clinical Services
•    Coverage determination reviews for medications that are non-formulary or are rejecting due to smart edits designed to stop potential drug-drug interactions or therapy/ingredient duplication.
•    Identify opportunities for medication therapy optimization, including (but not limited) to the following:
i.    Identification of therapeutic or ingredient duplication
ii.    Identification of drug-drug interactions between different ARVs and non-ARVs
iii.    Modifying dosing frequency
iv.    Medication consolidation (i.e. use of co-formulated products)
v.    Adding or removing medication components in regimens
vi.    Ensuring that regimens are complete (HAART) as recommended by national guidelines


 •    Outreach providers (by fax and phone) with detailed member-specific ARV medication fill history in addition to regimen assessments with potential areas of improvement
•    Viral load documentation to promote viral load suppression and identify prioritization of case management.
i.    Tracking viral load laboratory data obtained through case management chart reviews and/or upon submission through prior authorization requests in a secured location in the shared drive as well as through a database (spreadsheet or other platform).


 •    Work with members and non-specialized providers to link HIV care to specialists to improve clinical outcomes.
•    Support staff training and development as required.
•    Participate in internal, Federal and State audits and NCQA accreditation surveys.
•    Other duties as assigned.

Qualifications:


Education/Experience: Bachelor’s degree or advanced degree (Pharm.D., M.S.) in pharmacy. 2+ years of mail order, retail, hospital or managed care pharmacy experience or 1+ years of pharmacy residency program experience.

Licenses/Certifications: Current state’s Pharmacist license with no restrictions.

 

Preferred Skills/Experience:
•    One year of pharmacy practice experience, preferred.
•    Managed care pharmacy experience, preferred.
•    Pharmacy Residency Certification, preferred.
•    AAHIVP certification, preferred.
•    Proficiency in Microsoft Office: Excel, Word, Access; Outlook; Internet.
•    Working knowledge of the Clinical Pharmacy environment.
•    Proficiency in reading, writing, and speaking English.
•    Knowledge of managed care pharmacy.
•    Business Analysis Knowledge: Skilled to work in a fast paced environment. Must have strong analytical and problem solving skills.
•    Customer Service: Skilled to communicate with all levels of management, internal and external customers. 
•    Ability to work well as a member of a team or alone.
•    Effective Business Communication: Skilled in communicating with technical and business constituencies in writing effective business specifications and requirements.
•    Flexible, accountable and adaptable with the ability to work under pressure to meet deadlines in a fast paced environment



Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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