Pharmacist, Clinical Services - Temp

Abarca Health•San Juan, PR

9d•Hybrid

About The Position

Abarca is seeking a Clinical Services Pharmacist to play a crucial role in evaluating coverage determination requests and developing/executing clinical programs aimed at improving health-related outcomes for beneficiaries. The role involves optimizing medication use, promoting health, wellness, and disease prevention through comprehensive medication reviews to identify, resolve, and prevent medication-related problems. This position is part of a revolution in healthcare, leveraging smarter technology to redefine pharmacy benefits.

Requirements

Doctoral Degree in Pharmacy is required.
Current and Active Pharmacy License from Puerto Rico is required.
3+ years of experience working with clinical operations, clinical programs or medication therapy management.
Excellent oral and written communication skills.
This position requires availability to work in a specified time zone or working schedule, accommodating the business needs of our clients and team members.

Nice To Haves

Experience working in pharmacy benefit management (PBM) industry.

Responsibilities

Perform comprehensive and targeted medication reviews to identify, resolve, and prevent medication-related problems and document the care delivered.
Use prescription and medical claims data and client formulary information to provide clinical recommendations.
Make recommendations regarding gaps in care, high risk medications, drug interactions, therapeutic and generic substitution, compliance, and adherence.
Collaborate with Health Educators and Case Managers to ensure MTM and other clinical programs participants receive all the necessary and relevant information.
Maintain up to date knowledge advances in drug therapies and management of chronic conditions; leverage knowledge for supporting programs and associated teams.
Constantly evaluate, analyze, and look for methods to streamline processes to ensure improved patient care, outcomes, and program quality.
Collaborate with cross-functional teams to plan and execute clinical projects, operationalize formularies and medication lists, and deliver the highest quality of service to clients and partners.
Support CMS Medicare STAR initiatives, Medicaid’s Health Care Improvement Program, and other clinical programs.
Participate in government and internal audits, and in the Pharmacy & Therapeutics Committee, preparing presentations and clinical recommendations.
Develop and document Clinical Policies and Procedures.
Evaluate coverage determination requests, ensuring that all coverage determinations and appeal responses are clinically appropriate and compliant.
Assist in providing clinical support, including drug information to the PA Customer Service Teams, to ensure appropriate clinical decisions are made for beneficiaries, before, during, and after point of sale.
Ensure CMS’ and URAC Compliance in all clinical processes executed.