Senior Pharmacist

Responsibilities

• Help shape the quality of health care in Florida through the Florida Medicaid Program.
• Maintain knowledge of statutes and rules concerning work‑related programs/initiatives, including Florida Statutes, Florida Administrative Code, U.S. Code of Federal Regulations, contract guidelines, provider handbooks, and federal laws and regulations.
• Coordinate projects and quality‑related programs; determine fiscal and clinical impact of changes or proposed changes in practices and health service delivery.
• Produce analytical and statistical reports; coordinate research and evaluations of initiatives; compose and review interoffice and external communications; coordinate the design and development of special reports from data maintained by subcontractors and the Agency.
• Research databases for evidence‑based literature (outcome studies) to support policy recommendations.
• Identify and document the need for special studies and projects to provide information and data for policy and program development activities.
• Review and analyze state and federal audit reports, program evaluations, monitoring reports, provider and recipient correspondence and other materials to determine the need for new or improved programs or major policy revisions.
• Identify, develop, and implement more effective methods for involving providers, recipients, and other departmental staff in policy and procedure revisions for Medicaid fee‑for‑service and managed care programs.
• Review major policy proposals with other department staff, the Drug Utilization Review Board, the Pharmacy and Therapeutic Committee, provider groups, and associations as needed.
• Maintain knowledge of organizational, operational, and programmatic concepts and practices applied by public, private, and nonprofit agencies and organizations engaged in pharmacy services activities.
• Maintain pharmaceutical knowledge of evidence‑based treatments for medical and mental health conditions.
• Maintain and apply professional expertise to the evaluation of medication best practice guidelines to improve health outcomes in the Medicaid population.
• Stay current with the scientific literature and provide clinical consultation to Agency staff as requested.
• Serve as the subject matter expert for reporting to federal agencies.
• Design and maintain clinical and operational oversight frameworks that evaluate pharmacy benefits compliance with state contractual requirements, preferred drug lists (PDLs), prior authorization (PA) criteria, utilization management standards, and applicable Medicaid policy.
• Utilize encounter data, pharmacy claims data, MCO contracts, and MCO policies and procedures to identify trends, outliers, inappropriate utilization patterns, and areas of financial or clinical risk requiring corrective action or escalation.

• One year of professional experience in the practice of pharmacy.
• Licensed as a Registered Pharmacist in accordance with Florida Statute 465.