WI Clinical Pharmacist- Remote

Summary

The Clinical Pharmacist supports efforts in the development of pharmacy solutions programs, including prior authorization (PA) criteria development, PA and appeal reviews, PDL management, and coordination of Pharmacy and Therapeutics (P&T) Committee and DUR Board meetings. Supports prospective and retrospective Drug Utilization Review (DUR) activities by reviewing physician prescribing patterns, consulting with physicians on these patterns using evidence-based best practices, and working closely with internal teams to refine pharmacy management solutions programs. Provides consultation on pharmacy-related issues to clinical operations representatives and supports successful implementation of programs for client organizations. Leads and/or supports operational initiatives and projects, including strategic planning, implementation, go-live, and ongoing oversight and management as required by the client and Gainwell.

Job Responsibilities

• Prior Authorization Criteria Development: Evaluates drug and drug class reviews based on sound, evidence-based research and widely accepted medical standards. Ensures evidence summaries support recommendations for Preferred Drug List (PDL) management and clinical prior authorization (PA) criteria. Develops clinical PA criteria recommendations and documentation for presentation to the P&T Committee and/or DUR Board.
• Provides thorough review of clinical and pricing data to support the P&T Committee or DUR Board in evaluating Gainwell clinical criteria and PDL recommendations for coverage and placement decisions.
• Engages in discussions with practicing physicians and other prescribers to consult on specialty medication prescribing, including clinical evaluation of specialty trends and impact.
• Retrospective DUR Initiatives: Regularly reviews and monitors prescription claims data and identifies prescribing outliers through internal and/or external pharmacy claims analysis to develop retrospective DUR initiatives. Presents initiatives to the P&T or DUR Board, including methodology, interventions, communications, and outcomes.
• Consultations/Interventions: Works with Gainwell staff to contact prescribers requiring consultation and provides coaching on prescribing practices identified as outliers. Reviews prior authorization data and identifies opportunities for intervention.
• Intervention Refinements: Collaborates on refinement of consultation scripting, incorporating feedback from outreach interactions to improve effectiveness.
• Operations: Contributes to pharmacy program operations by supporting implementation and management of written and verbal communications to physicians and prescribers, as well as maintaining edits and data elements supporting those processes. Provides consultation on pharmacy-related questions and updates clinical and outreach programs as needed.
• Prior Authorization: Supports all prior authorization needs of the client.
• Project Management: Leads and/or supports operational initiatives and projects, including strategic planning, implementation, go-live, and ongoing oversight and management as required by the client and Gainwell.
• Quality Improvement: Supports program improvements through continuous quality improvement processes, proactively identifies opportunities for enhancement, and contributes ongoing consultation and collaboration with product leaders.
• Medical/Clinical: Maintains clinical integrity of pharmaceutical solutions by staying current on medication information, contributing to pharmacy best practices, collaborating with Medical Directors and clinical teams, and providing pharmacy expertise within the organization.
• Contributes innovative solutions to improve operational efficiency and effectiveness of the pharmacy team.
• Coordinates with operations, clinical, medical, reporting, and other internal departments as needed.

Requirements and Experience

• Experience in coordination and collaboration of work teams preferred.
• Registered Pharmacist with active State Licensure.
• PharmD (preferred) or Bachelor of Pharmacy degree.
• Minimum of 5 years of experience in clinical pharmacy or PBM.
• Experience in coordination and collaboration of work teams preferred.
• Knowledge of Medicaid at the state and/or federal level.
• Knowledge of pharmacy-related aspects of Medicaid.
• Experience with P&T Committee and DUR Board participation.

Knowledge, Skills, Abilities

• Ability to communicate clearly and accurately in both written and verbal English.
• Ability to perform clinical reviews using relevant compendia and clinical trial data.
• Managed care pharmacy experience is a plus.
• Strong research and implementation skills in practical settings.
• Strong analytical skills with ability to translate findings into practical recommendations.
• Strong team orientation with respect for all members.
• Strong interpersonal skills to support collaboration with internal and external stakeholders.
• Excellent organizational, written, and verbal communication skills.
• Maintains confidentiality and complies with HIPAA requirements.
• Proficient in Microsoft Office applications and ability to learn proprietary systems quickly.
• Strong organizational and problem-solving skills.

What to expect

• Remote within the U.S.
• 5% of travel

This posting is intended for pipelining purposes and will remain open to accept applications on an ongoing basis.