Clinical Review Pharmacist

HealthPartners • Bloomington, MN

5d

About The Position

Service excellence is to be centered on patient care and patient relationships
and is the responsibility of all employees. Teamwork is the norm and all
employees will be held accountable to work as effective team members. To review,
approve and deny prior authorization requests in compliance with pharmacy
policies, procedures, and standards. Provide support to physicians and pharmacy
staff regarding prior authorization questions.

Requirements

• Must be a graduate from an accredited college of pharmacy and licensed as a pharmacist in the state of Minnesota
• Must maintain this license in good standing as required by Minnesota law
• Must meet one of the following: Pharm.D.
• One year of recent experience in a managed care pharmacy setting
• One year of recent clinical pharmacy experience that includes prior authorization experience
• Demonstrated knowledge of pharmacodynamics, and pharmacokinetics, pathophysiology and therapeutic disease states commonly found in ambulatory patients
• Demonstrated competency in all professional aspects of pharmacy
• Strong leadership and organizational skills. Maturity and dependability are essential
• Ability to organize and function under stress with many interruptions
• Ability to establish and maintain effective, friendly and courteous working relationships with coworkers, physicians and patients
• Strong communication / listening skills and good telephone etiquette
• Ability to accept and implement change
• Ability to tactfully resolve complaints
• This position requires close visual perception and the ability to sit or stand for prolonged periods at a time. Must possess speech, hearing and sight skills to perform the functions of the position. Requires coordinated dexterity of hand, sensory acuity, and verbal ability. Must be able to speak, read and write English proficiently. Proficiency in other languages may be required.

Nice To Haves

• Experience working with pharmacy technicians
• Experience working with Microsoft suite of products
• Knowledgeable in CMS and DHS regulations as well as other compliance related rules and entities

Responsibilities

• Review prior authorization requests for medical policy drugs (in clinic, home infused) and pharmacy benefit drugs; make coverage determinations for drug products according to member benefits and coverage criteria.
• Contribute to the development, maintenance and communication of utilization management and exception criteria.
• Provide clinical guidance and support to the Pharmacy Customer Service Assistants and other Pharmacy staff when requested.
• Provide research and analysis of coverage determinations and appeals on an ad hoc basis.
• Provide support and follow up for escalated clinical issues.
• Research drug information to maintain drug knowledge and disease state understanding for application to drug coverage reviews.
• Apply drug knowledge and evidence from literature to specific case situations, discussions with Medical Directors, and other peer review groups.
• Provide effective drug information and consultation to professional staff, providers, patients and members.
• Responsible for strict adherence to the requirements of CMS, DHS, MDH and other regulatory agencies.
• Support and cooperate with other departments’ operation initiatives.
• Maintain a professional image.
• Adhere to the established Group Health, Inc., patient-service standards.
• Perform other duties as assigned.

Benefits

• Benefits Designed to Support Your Total Health As a HealthPartners colleague, we’re committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Ph.D. or professional degree