Lead Pharmacist, Clinical Retrospective Case Management

• Review and interpret client data to identify, develop, and manage high-cost clinical interventions and casework
• Evaluate clinical research and financial data to develop strategic medication management options and coverage recommendations
• Manage retrospective case requests in compliance with established clinical criteria
• Assist in developing clinical policies and pharmacy benefit management programs
• Contribute to clinical program development for medical and pharmacy benefits
• Complete claims editing and audits to ensure accuracy and compliance
• Develop and deliver data-driven clinical messages to physicians, members, and other clinicians
• Serve as a peer-to-peer consultant presenting complex clinical and cost-effectiveness information
• Define, document, and present clinical intervention and program results to plan sponsors
• Monitor the case queue and ensure teammates work cases proactively and productively
• Complete training, coach, and develop teammates
• Identify areas of improvement and implement solutions
• Support compliance and diversity, equity, and inclusion objectives
• Perform other duties as assigned

• Doctor of Pharmacy (PharmD) required
• Current, unrestricted licensure as a Registered Pharmacist in the state of residence, or ability to gain reciprocity within 4 months, may be required based on state laws or client contracts
• Other State Pharmacy Licenses may be required as business need dictates
• Must continually maintain education credits to maintain active licensure
• Board of Pharmacy certification preferred for Pharmacotherapy, Ambulatory Care or Oncology Care
• Pharmacy and Medical specialty benefit knowledge and experience required
• 3 years clinical or managed care experience or Clinical/Managed Care Pharmacy Residency preferred
• Proficient in Microsoft Excel, PowerPoint, and Word

Demonstrates expertise in clinical intervention management, medication management strategies, and compliance with clinical criteria. Proficient in developing clinical policies and delivering data-driven messages to healthcare professionals.

• Doctor Of Pharmacy (PharmD)
• Registered Pharmacist Licensure
• Clinical/Managed Care Experience
• Pharmacy Benefit Management
• Microsoft Excel Proficiency

• Clinical Intervention Management
• Medication Management
• Claims Editing
• Data Analysis
• Clinical Program Development

• Coaching
• Team Development
• Problem Solving
• Communication

• Board Of Pharmacy Certification
• Pharmacotherapy Certification
• Ambulatory Care Certification
• Oncology Care Certification

• Pharmacy Benefit Management Programs
• Clinical Research
• Cost-Effectiveness Analysis
• Diversity, Equity, And Inclusion Objectives

• Microsoft Power Point
• Microsoft Word