Clinical Formulary Pharmacist

Centene Corporation•New York, NY

2d•$107,700 - $199,300•Hybrid

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. This role involves assessing drug use trends, new drug releases, and reviewing primary literature to develop drug product review and formulary recommendations. The pharmacist will analyze pharmacy cost of care and trends, coordinate the development of appropriate use protocols and guidelines, and set criteria for medication analysis. They will also coordinate reports to clients, meet regulatory reporting requirements for drug utilization review and fraud and abuse reporting, and develop clinical criteria for reviewing non-formulary or non-preferred drug list medications, communicating recommendations to clients. Additionally, the role involves developing and designing clinical edits to adjudicate claims and enhance drug utilization, and developing and reviewing guideline criteria for prior authorization and non-formulary drugs to support the Pharmacy and Therapeutics Committee function and pharmacy benefit design. The pharmacist will research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews, and provide clinical guidance and support to assigned pharmacy technicians. Finally, they will provide support documentation and develop communication for the Pharmacy & Therapeutic (P&T) Committee review process and decisions.

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.

Nice To Haves

Experience supporting Prior Authorization processes, preferably within Medical Pharmacy.
Strong background working with Decision Trees, including testing, reviewing, and interpreting clinical criteria.
Experience with the ComPass system.
Proficiency in Visio, Excel, and Word.
Available to work a schedule that may begin as early as 9:30 AM EST.

Responsibilities

Define and develop 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.