Clinical Pharmacist - (February) at Magellan Health Services inc in rancho cordova, California

Job Description:

Ready for a rewarding career \"to help lead humanity to healthy, vibrant lives?\" As a Clinical Pharmacist, you'll be using references and guidelines to support your review of prior authorization requests for medications within regulatory and contractual obligations of all parties involved.
Primary Responsibilities

• Work is computer based and includes receiving phone calls from prior authorization pharmacy technicians and/or providers for clinical information.


• Makes outbound or takes inbound telephone calls to assist in various aspects of patient care and/or product distribution to/from practitioners, members, and pharmacies. These calls include, but are not limited to, comprehensive medication reviews, targeted medication reviews, call to practitioners about product awareness, and prior authorizations.

• Performs prospective and/or retrospective drug utilization review and appeals per State and Federal regulations. Participates in the distribution of clinical drug information and educates providers and staff regarding the use of pharmaceutical treatment regimens. Complies with all corporate and facility standard operating procedures, policies, guidelines, and work instructions.


• Provides prior-authorization services for formulary drugs, develops programs to provide optimal pharmacy care to patients, participates in drug utilization review programs, reviews assessment and documentation of patient care, and retrospective reviews of provider reimbursement. Makes recommendations to physicians and other prescribers on medication regimens as per plan guidelines. Assists providers to ensure accurate dispensing and billing of products.


• Ensures compliance with Federal and State laws and standards of practice which govern the profession of pharmacy. Maintains pharmacy records in accordance with all applicable state and federal laws and regulations. Maintains clinical skills and knowledge of pharmacotherapy by reviewing the literature, continuing education and any company provided in-services. Completes all mandatory company provided on-line courses. Attends and completes all employee development courses.


• Participates in mandatory on-call rotation when required by business needs.

Required Qualifications

• RPH license must be current and in good standing in the state of CA


• Candidates will need either a Bachelor of Pharmacy or Doctorate of Pharmacy from an accredited school of pharmacy.


• Minimum of 1 year experience as a licensed RPh

Preferred Qualifications

• Strong drug product and clinical pharmacy knowledge.

• Experience in Clinical Contact Center environment.


• Experience completing case reviews to arrive at evidence-based recommendations.


• Be able to execute and deliver within the confines and timeframes provided by Medicaid which may include non-standard business hours.


• Experience interpreting medical guidelines and drug compendia.


• Previous experience working within a PBM or Health Insurance Plan.

Other Job Requirements

Responsibilities
License must be current and in good standing.Strong drug product and clinical pharmacy knowledge.

General Job Information

Title
Clinical Pharmacist - (February)

Grade
28

Work Experience
Pharmacy

Education
Bachelors: Pharmacy (Required), PharmD: Pharmacy

License and Certifications - Required
RPH - Registered Pharmacist - Pharmacy

License and Certifications - Preferred
PharmD - Doctor Of Pharmacy, State Licensure - Pharmacy

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.