Pharmacist Health Plan

Location: Work from home (Pennsylvania)

Shift: Days (United States of America)

Scheduled Weekly

Hours:

40

Worker Type: Regular Exemption Status:
Yes

Depending on assigned area of expertise, the pharmacist will perform a variety of duties, including performing extensive literature review for the development of criteria for management of the pharmacy benefit, administering the pharmacy benefit in conjunction with the Health Plan Pharmacy Customer Service team members, delivering continuous, high quality member care while maximizing member satisfaction and managing appropriate utilization, among others duties assigned.

• Act as a liaison between the Health Plan and its customers with respect to pharmaceutical benefits.
• Serve as formulary expert for all lines of business and associated benefit designs.
• Support internal operations to provide information to our customers regarding pharmacy and medical drug benefits, formulary details, and prior authorization details as needed.
• Support prior authorization representatives in duties related to medical necessity, formulary exceptions, and prior authorization reviews.
• Perform medical necessity reviews for formulary exceptions and prior authorizations according to specified timelines.
• Pharmacy utilization management activities will be performed only after obtaining an active, unrestricted pharmacy license.
• Perform extensive literature review and develop clinical criteria for new and existing pharmaceuticals as part of a drug review function to be presented at the Pharmacy and Therapeutics Committee.
• Work closely with clinical enterprise to coordinate the best, most cost‑effective drug selection policies and protocols for targeted disease processes.
• Suggest improvements and changes to perpetually improve operations.

This position primarily focuses on medication therapy management (MTM) outreach for Medicare Part D members.

Education: Bachelor's Degree (Required), Bachelor's Degree in Pharmacy (Preferred)

Certification(s) and License(s):
Licensed Pharmacist (Pennsylvania) within 90 days – State of Pennsylvania

Application Delivery Process, Teamwork

We are an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran. Women and minorities are encouraged to apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.