Clinical Review Pharmacist

AmTrust Financial Services•Dallas, TX

9d•$116,000 - $120,000•Hybrid

About The Position

AmTrust Financial Services, a fast-growing commercial insurance company, has a need for a Clinical Pharmacist. This role is out of one of our office locations in the United States on a hybrid schedule. PRIMARY PURPOSE: The Clinical Review Pharmacist has the responsibility of reviewing the medical necessity, appropriateness, and quality in the appropriate setting for workers’ compensation injured employee as it pertains to their medications. Additionally, they will work with Amtrust adjusters and nurses to take proper interventions in the care of the injured employee. This position primarily requires timely reviews of pharmacy prior authorizations to determine appropriateness and medical necessity of treatment. This position assesses the medical appropriateness of proposed medications for our injured employees and partners with the AmTrust claims team to expedite medically necessary treatment.

Requirements

3+ year of experience in pharmacy clinical care
Pharmacy B.S or Pharm D
Strong documentation skills
Strong communication and presentation skills

Nice To Haves

Prior Authorization
Pain management treatment protocols and clinical guidelines
Excellent oral and documentation communication skills
MTM certifications
Workers’ compensation managed care treatment
Clinical guidelines and formulary management

Responsibilities

Review prescription prior authorizations in the timeliest manner.
Any supporting clerical tasks associated with pharmacy authorizations/reviews.
Document medication determination based on professional clinical judgement, evidence-based guidelines, clinical treatment guidelines, state specific workers’ compensation formularies, and third-party Utilization Review when appropriate.
Document judgement on medication determinations on multiple platforms.
Recommend to the appropriate party alternative medications, alternative dosing, or other modifications (including discontinuation of medications) as appropriate.
Reviews therapy plans with case nurses as needed.
Escalate cases for multi-disciplinary reviews.
Telephonic engagement with providers for peer-to-peer interventions
Participate in clinical quality audits for inter-rater reliability assurance and support
Pharmacists review medication orders for completeness, accuracy, and legality, determining the presence of medication therapy problems in a patient’s current medication therapy, including, for example, any of the following:
Medication prescribed inappropriately for a particular medical condition
Current medication therapy regimen is inappropriate (dose, dosage form, duration, schedule, route of administration, method of administration)
There is therapeutic duplication
Provide pharmacological information by answering questions and requests of health care professionals and adjusters
Maintain privacy and confidentiality of all records while adhering to ethical, legal, and regulatory standards.
Ability to work independently and prioritize workload