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Louisiana DUR Pharmacist

Date:  Sep 19, 2022

Any city, LA, US, 99999

Req ID:  14152


The Drug Utilization Review (DUR) and analytics pharmacist primarily supports Prospective and Retrospective DUR activities, reporting as well as administering a lock-in program.  Their role includes identifying and implementing RetroDUR initiatives using evidence-based best practices as well as ongoing and periodic examination of claims data to identify patterns of fraud, abuse, gross overuse, or medically unnecessary care.  Initiatives may be associated with specific drugs or groups of drugs and are designed to implement corrective action when concerning drug utilization patterns are identified.  This role involves working closely with the account pharmacy manager and the Louisiana Department of Health (LDH) pharmacists in the refinement of the pharmacy management programs and facilitating the successful implementation of these programs for our State customers.

Your role in our mission

Primary DUR pharmacist for the account providing services to LDH with their DUR initiatives and programs.
Coordinate and conduct the state-wide quarterly DUR Board meetings. Coordinate and manage the four regional DUR committees.
Retro DUR Initiatives:  Regularly reviews and monitors prescription claims data and prescribing practices identified as outliers by internal and/or external analysis of pharmacy claims data to develop relevant Retrospective DUR initiatives.  Present initiatives to the DUR Board and four DUR regional committees including methods, interventions, communication, and outcomes.
Contacting physicians and prescribers identified as needing consultation to provide coaching on prescribing practices that have been identified as outliers. 
Provides clinical review of weekly drug file updates to maintain DUR programs and pharmacy claim processing.
Intervention Tracking and Documentation:  Tracks contact attempts and contacts per operations procedures.  Documents content of and results of consultations as defined in operations procedures; maintains records as required.
Intervention Refinements:  Collaborates on the refinement of consultation scripting; solicits and utilizes input from those contacted toward scripting improvements.
Provide reporting functions including:
Pharmacy and PAD utilization and cost reports
Analytics-review results and develop action plan
Algorithms to identify what initiatives to pursue
Annual CMS Report
Maintain a lock-in program
Provide analytics functions of pharmacy claims for purposes of identifying billing outliers, opportunities for clinical interventions, and working with the fraud, waste, and abuse staff.
Experience in performing Prospective and Retrospective Drug Utilization reviews preferred.
Experience with coaching physicians and prescribers on medication issues.
Analytical skills which can translate into practical and pragmatic recommendations.
Strong team orientation with respect for all members.
People skills are essential that allow for successful consultation and collaboration with internal and external stakeholders who do not directly report to this job.

What we're looking for

  • PharmD  or B.S. in Pharmacy with relevant Specialty background  
  • Licensed to practice in Louisiana as a pharmacist
  • Two (2) years full-time experience as a consultant or medical review staff member in a Medicare, state-level Medicaid program or large health care organization
  • 4 years' experience in clinical pharmacy
  • Strong verbal and written communications skills.
  • Highly skilled with Microsoft office products and ability to quickly learn proprietary systems.

What you should expect in this role

Remote as well as in-office meetings as required.

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