Clinical Pharmacist Advisor
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Job Description
Clinical Pharmacist Advisor managing Medicaid prescription drug program. Conducting clinical evaluations, collaborating with providers, and supporting state pharmacy audits.
Responsibilities:
- Conduct clinical evaluations of medication therapy and review prior authorization requests using PDL criteria
- Facilitate peer-to-peer discussions with providers regarding prior authorization decisions
- Collaborate with prescribers and internal teams on clinical consultations and targeted interventions
- Support call center operations by providing clinical guidance and assisting with provider/member communications
- Serve as a subject matter expert for pharmacy-related questions across the organization
- Contribute to quality improvement initiatives and program enhancements
- Maintain clinical expertise and collaborate with cross-functional teams on pharmacy best practices
- Provide input on drug utilization reviews and formulary management
- Support Medicaid Drug Rebate Program operations and assist with state pharmacy audits
- Deliver training to pharmacy providers and contribute to reporting and administrative activities
Requirements:
- Registered Pharmacist with respective State Licensure
- PharmD (preferred) or Bachelor of Pharmacy degree
- At least 5 years of experience working in a pharmacy setting or pharmacy benefit management system
- Knowledge of Medicaid at the state and/or federal level
- Knowledge of pharmacy-related aspects of Medicaid
- Working knowledge of HIPAA regulations and requirements.
Benefits:
- generous, flexible vacation policy
- 401(k) employer match
- comprehensive health benefits
- educational assistance
- leadership and technical development academies
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