Lead Pharmacist, Clinical Retrospective Case Mgmt - Archimedes

Navitus Health Solutions•Earth City, MO

2d•Hybrid

About The Position

The Lead Pharmacist, Clinical Retrospective Case Management will be divided into two areas: external clinical outreach activities related to high-cost case management and prior authorization of specialty medications, across pharmacy and medical benefits and specialty and traditional drugs. In addition, this role will have the opportunity to evaluate the data to identify actionable opportunities for specialty management and create clinical policies. The Lead Pharmacist, Clinical Retrospective Case Management is responsible for being the clinical expert for all specialty medications across both the pharmacy and the medical benefit. This role will be able to successfully communicate 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. Clinical subject matter expert is required to conduct peer to peer consultations with physicians.

Requirements

Doctor of Pharmacy (PharmD) required.
Current, unrestricted licensure as a Registered Pharmacist in the state of residence, or the ability to gain reciprocity within 4 months, may be required based on state of residence laws or client contracts.
Other State Pharmacy Licenses may be required as business need dictates.
Must continually maintain education credits to maintain active licensure.
Pharmacy and Medical specialty benefit knowledge and experience required.
Proficient in Microsoft Excel, Power Point and Word.

Nice To Haves

Board of Pharmacy certification preferred for Pharmacotherapy, Ambulatory Care or Oncology Care.
3 years clinical or managed care experience or Clinical/Managed Care Pharmacy Residency preferred.

Responsibilities

Review and interpret client data to identify, develop, and manage high-cost clinical interventions and casework.
Evaluate clinical research and financial data to develop strategic medication management options and coverage recommendations.
Manage retrospective case requests in compliance with established clinical criteria.
Assist in the development of clinical policies and pharmacy benefit management programs.
Contribute to clinical program development for both medical and pharmacy benefits.
Complete claims editing and audits to ensure accuracy and compliance.
Develop and deliver clear, data-driven clinical messages to physicians, members and other clinicians.
Serve as a peer-to-peer consultant, effectively presenting complex clinical and cost-effectiveness information to various stakeholders.
Define, document, and present results of clinical interventions and programs to plan sponsors.
Monitor case queue and ensure teammates are working cases in a proactive, productive manner.
Complete necessary training, coaching and develop teammates.
Identify areas of improvement and implement solutions.
Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.
Other duties as assigned.