Clinical Formulary Pharmacist

Centene Corporation

1d•Remote

About The Position

The Clinical Formulary Pharmacist defines and develops standard and custom formularies for all lines of business including Commercial, Medicaid, Medicare Part D and the Health Information Marketplace. Develop drug product review and formulary recommendations by assessing drug use trends, new drug releases and review of primary literature. Analyze pharmacy cost of care, trends, and coordinate the development of appropriate use protocols and guidelines. Set criteria for medication analysis, coordinate reports to clients, meet regulatory reporting requirements for drug utilization review and fraud and abuse reporting. Develop clinical criteria for review of non-formulary or non-preferred drug lists medications and communicate recommendations to clients. Develop and design clinical edits to adjudicate claims and enhance drug utilization. Develop and review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design. Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews. Provide clinical guidance and support to the assigned pharmacy technicians. Provide support documentation and develop communication for the Pharmacy &Therapeutic (P&T) Committee review process and decisions. Other duties as assigned.

Requirements

Bachelor’s degree or advanced degree (PharmD, MS) in pharmacy.
3+ years of combined managed care pharmacy or pharmacy residency program experience.
Current, valid and unrestricted state’s Pharmacist license.

Responsibilities

Defines and develops standard and custom formularies for all lines of business including Commercial, Medicaid, Medicare Part D and the Health Information Marketplace.
Develops drug product review and formulary recommendations by assessing drug use trends, new drug releases and review of primary literature.
Analyzes pharmacy cost of care, trends, and coordinates the development of appropriate use protocols and guidelines.
Sets criteria for medication analysis, coordinates reports to clients, and meets regulatory reporting requirements for drug utilization review and fraud and abuse reporting.
Develops clinical criteria for review of non-formulary or non-preferred drug lists medications and communicates recommendations to clients.
Develops and designs clinical edits to adjudicate claims and enhance drug utilization.
Develops and reviews guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design.
Researches drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews.
Provides clinical guidance and support to the assigned pharmacy technicians.
Provides support documentation and develops communication for the Pharmacy &Therapeutic (P&T) Committee review process and decisions.
Other duties as assigned.