Location: San Diego, CA Remote Location: # of openings: 1 Department: Employment duration: Full time Exemption Status: Exempt Relocation Assistance: N/A Added to system: 1/6/23 11:53 AM Job Code: 390.230106.8020

Description

Clinical Prior Authorization Guideline Pharmacist

$104,342 - $146,600 - $188,858

“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!

The Scoop:

The Department of Clinical Formulary provides drug data management and clinical formulary strategy for all MedImpact National Formularies. The Clinical Prior Authorization Guideline Pharmacist works in collaboration with Drug Information, PA/UM, Formulary Services, CPM, Specialty and other departments to provide PA guideline set creation and maintenance for all lines of business. The Clinical PA Guideline Pharmacist ensures that clinical and financial strategies, set by the client or internal, are reflected in the PA guidelines and that the guidelines are compliant with Federal and State regulations. The Clinical PA guideline pharmacist supports Drug Information and CPMs with the creation and maintenance of standard and custom PA guidelines for all lines of business. Ensures plan specific policies are followed.

What You Get To Do:

• Creates PA guideline sets for custom clients for all lines of business (Medicare Part D, Medicaid and Commercial) during implementation)
• For Part D: ensures that the criteria in the PA reflect the information in the PAST template and the quantity limit on the formulary.
• Ongoing maintenance of the Standard MedImpact Part D, Medicaid and Commercial/HCR PA guideline sets.
• Create new prior authorization guidelines in response to newly approved therapeutic agents, patent expirations, FDA alerts and drug recalls or withdrawals.
• Provides support for Drug Information, Clinical Program Managers (CPM), Client, CMS and State audits.
• Stays abreast of new regulations to ensure regulatory compliance of prior authorization guidelines.
• Researches and appropriately responds to PA guideline coding and rationale questions.
• Analyzes PA utilization and cost avoidance for standard clients.
• Develops standardized reporting to demonstrate PA clinical and financial effectiveness.

Supervisory Responsibilities

This job has no supervisory responsibilities.

Client Responsibilities

This is primarily an internal client facing position but will require external client communication from time to time. The incumbent is required to have excellent customer service skills and interpersonal communication skills (listening/verbal/written).

Education and/or Experience

For consideration candidates will need:

• Pharmacy degree (Pharm. D.) or equivalent
• Two (2) to five (5)+ years related experience and/or training in formulary management or similarly related duties or equivalent combination of education and experience
• Completion of a Managed Care or Clinical Residency program desired

Computer Skills

To perform this job successfully, an individual should have knowledge of Microsoft Office Suite Word and Excel software.

Certificates, Licenses, Registrations

Active, unrestricted registered pharmacist license in at least one state in the United States is required.

Other Skills and Abilities

Excellent working knowledge of all types of pharmacy services (retail, home infusion, inpatient) with an emphasis on the managed health care environment. Managed Care residency, and/or other clinical experience is preferred.

Travel

This position requires no travel; however, attendance may be required at various local conferences and meetings.

The Perks:

• Medical / Dental / Vision / Wellness Programs
• Paid Time Off / Company Paid Holidays
• 401K with Company match
• Life and Disability Insurance
• Tuition Reimbursement
• Employee Referral Bonus

This position is eligible for Employee Referral Bonus at Level IV.

To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers

MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.

Equal Opportunity Employer, Male/Female/Disabilities/Veterans

OSHA/ADA:

To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Disclaimer:

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.