Per Diem Pharmacist
About The Position
EmpiRx Health [https://www.empirxhealth.com/] is the leading clinically-driven pharmacy benefits management company. As the pioneer in value-based pharmacy care, EmpiRx Health puts its customers and members first by enabling them to take control of their pharmacy benefits, healthcare outcomes, and financial results. We place more emphasis on member care than any other PBM by focusing on health outcomes first. Our pharmacists and clinicians are at the center of everything we do―and our population health solution delivers tailored strategies for our clients. Leveraging our newly launched, AI-powered pharmacy care platform, Clinically [https://clinically.co/]™, EmpiRx Health’s pharmacists and client experience teams provide the highest quality pharmacy care to our clients and their members. This enables benefits plan sponsors to keep their members healthy, happy, and productive, while substantially reducing prescription drug spending, which has been on an explosive growth trajectory in recent years. In this critical role, the Per Diem Pharmacist ensures clinical prior authorization and appeal determinations are completed in accordance with covered plan design while delivering clinically appropriate pharmacy care and driving sustainable clinical savings for clients. The pharmacist supports EmpiRx Health’s Population Health Management model through collaboration, evidence-based decision-making, and proactive engagement with providers.
Requirements
- Pharm.D. degree from an accredited college of pharmacy (Required).
- Minimum of 3 years of pharmacy experience in clinical, PBM, or managed care settings.
- Active Pharmacist License in good standing (Required).
- Strong clinical judgment and analytical thinking skills.
- Exceptional written and verbal communication.
- High attention to detail and accuracy in documentation.
- Excellent organizational and multitasking abilities.
- Proficient in Microsoft Office Suite and pharmacy systems.
- Ability to work independently and collaboratively in a fast-paced environment.
Nice To Haves
- Prior experience with prior authorization, utilization management, or health plan operations preferred.
Responsibilities
- Act as a clinical expert on prior authorization review and evaluation in accordance with clinical criteria and covered plan design.
- Review, evaluate, and resolve all assigned clinical reviews through comprehensive case review and direct physician engagement aligned withEmpiRxHealth’s Population Health Management model.
- Perform peer-to-peer reviews with providers as needed or when requested.
- Convey clinical determinations promptly within established turnaround time requirements to prescribers, members, and healthcare professionals following established approval and denial protocols.
- Monitor and proactively identify clinical interventions to ensure clinical savings guarantees are met.
- Review and evaluate current clinical literature to support recommendations and decision-making.
- Participate in continuous quality improvement initiatives to streamline clinical review processes and enhance member care.
- Stay informed onEmpiRxHealth formulary updates, clinical programs, and internal policies.
- Provide guidance and support to members, providers, and other healthcare professionals regarding clinical inquiries.
- Collaborate with clinical technicians and prior authorization team members to facilitate clinical review requests, resolve escalations, and answer inquiries.
- Act as a clinical resource for internal staff, supporting staff training and development as needed.
- Proficiently utilize pharmacy management software for case documentation and communications.
- Proficiently utilize Microsoft Office tools to support analysis and reporting.
- Utilize external clinical and drug information resources (e.g., IPD, Policy Reporter, UpToDate,MediSpan) to support reviews, decisions, and awareness of emerging drugs.
- Collaborate cross-functionally with internal clinical teams for claim/data review, clinical interventions, and provider/member/client support as required
Benefits
- Paid Time Off
- a 401(k) program
- Health Insurance including Dental & Vision coverage
- Health Savings Account
- Employee Assistance Program
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What This Job Offers
Career Level
Mid Level
Education Level
Ph.D. or professional degree
