Lead Clinical Pharmacist, Utilization Management - Archimedes
About The Position
Archimedes is a specialty drug management company with industry-leading technology and services that health plans and employer groups can use to manage specialty drug spend. We are expanding our team and looking for a clinical professional who has specialty drug management experience and a passion for cost management. Given our continued growth trajectory, we are looking for a person who can grow with the company. This role will be divided into two areas: managing the team Key performance metrics, queue and performance guarantees and conducting external clinical outreach activities related to high-cost case management and prior authorization of specialty medications, across pharmacy and medical benefits and specialty drugs. In addition, this role will have the opportunity to evaluate the data to identify actionable opportunities for specialty management, create clinical policies and build out the RxPreCheck technology and reporting. The Lead Pharmacist of Utilization Management is responsible for being the clinical expert for all specialty medications across both the pharmacy and the medical benefit. This individual will be able to successfully lead the pharmacy technicians. This role also needs to be a player-coach role, so directly communicating with physicians, nurses, pharmacists, and members related to high-cost case concerns, dose management, genetic testing, therapeutic substitutions, and cost management related to specialty drugs if required. Clinical subject matter expert is required to conduct peer to peer consultations with physicians.
Requirements
- Doctor of Pharmacy (PharmD)
- Current pharmacist license (RPh)
- Pharmacy and Medical specialty benefit knowledge and experience
- Independent, proactive, forward-thinking, creative problem solver, results-oriented
- Ability to work well in team environment
- Strong verbal/written communication skills
- Strong physician-facing clinical communication skills
- Microsoft Excel, Power Point and Word proficiency
Nice To Haves
- 3 years clinical or managed care experience or Clinical/Managed Care Pharmacy Residency preferred.
Responsibilities
- Develop and manage pharmacy technicians on Clinical operations team
- Manage state licensure needed for Utilization Management
- Communicate and track all KPIs related to the Clinical operations team
- Ensure drugs reviewed are appropriate under the plan’s benefit
- Develop and deliver clinical messages to physicians, members, clients, and consultants
- Manage prior authorization, high-cost cases, medical to pharmacy conversions, claims editing and clinical policy development
- Clinical program development including both medical and pharmacy benefit management
- Define, document, and deliver results for plan sponsors.
- Evaluate and summarize clinical literature as well as financial implications related to medication management options
- Ability to present deep clinical and cost effectiveness information as a peer-to-peer consult.
Benefits
- Top of the industry benefits for Health, Dental, and Vision insurance
- 20 days paid time off
- 4 weeks paid parental leave
- 9 paid holidays
- 401K company match of up to 5% - No vesting requirement
- Adoption Assistance Program
- Flexible Spending Account
- Educational Assistance Plan and Professional Membership assistance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Ph.D. or professional degree
