Clinical Pharmacist - SCAN Temp
About The Position
The Clinical Pharmacist - SCAN Temp will play an instrumental role in ensuring compliance and clinical appropriateness of Part D coverage determinations, appeals and grievances, and Part C organizational determinations for a senior-focused Medicare Advantage Plan. The Clinical Pharmacist will work alongside the Director to execute and ensure CMS compliant operations and strong star rating performance for these areas. In addition, the Clinical Pharmacist will support Interdisciplinary Care Team work, and complete medication-related clinical reviews to support the care management teams at SCAN. The Clinical Pharmacist will participate in other managed care responsibilities as assigned. This position reports into the Manager, Pharmacy Experience & Access.
Requirements
- 3-5 years of related experience.
- Performs work under minimal supervision.
- Bachelor's Degree or equivalent experience.
- Handles complex issues and problems, and refers only the most complex issues to higher-level staff.
- Possesses comprehensive knowledge of subject matter.
- Provides leadership, coaching, and/or mentoring to a subordinate group.
- Ability to work as part of a team.
- Ability to foster teamwork.
- Decision-making skills.
- Strong oral and written communication skills.
- Ability to build collaborative relationships.
- Customer/client orientation.
- Detail oriented.
- Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams), Visio.
Nice To Haves
- Curious about AI and its power to transform how we operate and serve our members.
Responsibilities
- Serve as a subject matter expert of Part D coverage determinations, redeterminations, and applicable Part C organizational determinations.
- Utilize Medicare Part D knowledge and expertise to ensure compliance and clinical appropriateness with coverage determinations, appeals, and grievances.
- Maintain current knowledge of relevant Medicare Part D regulations by participating in CMS calls and reading released guidance and implementing changes/updates to maintain compliance.
- Produce and maintain Prior Authorization criteria and Step Therapy criteria in accordance with CMS requirements on monthly and annual basis.
- Maintain professional and technical knowledge by attending educational workshops.
- Develop and maintain formulary exception criteria.
- With direction from the Manager, develop, coordinate and implement an effective on-going strategy to achieve strong star ratings and audit readiness for assigned functions.
- Serve as the clinical appropriateness subject matter expert during regulatory audits.
- Ensure rigorous daily monitoring of operations for compliance performance.
- Contribute in quality improvement and process enhancement projects internally and with contracted PBM.
- Foster strong relations with internal departments and contracted PBM.
- Serve as pharmacy expert on Interdisciplinary Care Team, other committees, and workgroups as required.
- Support the care management teams by reviewing records of patients to determine the appropriateness of medication therapy, consulting on dosages, and collaborating with healthcare professionals to ensure optimal patient care.
- Serve a clinical bridge to the Formulary & Benefits team on effectiveness and considerations for additional formulary utilization management strategies.
- Actively support the achievement of SCAN’s Vision and Goals.
- Other duties as assigned.
Benefits
- Medical Benefits
- Paid Sick Time
- Excellent 401(k) Retirement Saving Plan
- Robust employee recognition program
- An opportunity to become part of a team that makes a difference to our members and our community every day!
- A competitive compensation and benefits program
- An annual employee bonus program
- Generous paid-time-off (PTO)
- Eleven paid holidays per year
- Excellent Retirement Savings program
- A work-life balance
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
