Clinical Pharmacist

Clinical Pharmacist

The Clinical Pharmacist will be the primary liaison for clinical and cost containment insights to the medical-only book of business for internal and external-facing clients. Responsible for overall retention and satisfaction within their book of business. Provide clients with appropriate utilization and financial reporting that includes summaries of key focus areas and recommendations. Serve as pharmacy SME in support of AMPS/Drexi client service staff.

Essential Job Duties:

• Maintain confidentiality and HIPAA guidelines to ensure the confidentiality of all members and clients.
• Provide overview and advice on local, state, and federal legislative, legal, and industry requirements for PBM practices, including but not limited to PPACA, HIPAA, etc.
• Review, edit, maintain, or create and support standard and client-specific drug formularies and formulary management efforts for PBM and RBR/MBR customers and prospects.
• Review, edit, maintain, or create and support standard and client-specific Prior Authorization protocols.
• Review and determine clinical dispositions regarding pharmacy, patient, and prescriber-generated prior authorization requests per established response guidelines determined by the company and its client contracts requirements.
• Review, edit, maintain, or create and support standard and client-specific MAC (Maximum Allowable Cost) lists and protocols.
• Support client retention, renewals, upsells and client satisfaction.
• Provide review and evaluation of client and prospect drug utilization review, provide financial and clinical insights to support internal and external client needs.
• Provide review and advice on Pharmacy Provider Contracting when required.
• Review, edit, maintain, or create and support standard and client-specific Drug Utilization and financial impact reporting protocols.
• Review, edit, maintain, or create and support the additions of new specialty, brand, and generic product introductions.
• Review, edit, maintain, or create and support standard and client-specific Rebate contracts and performance guarantees associated with such contracts.
• Review, edit, maintain, or create and support the development of an organizational standard for MSP (manufacturer savings programs), PAP (patient assistance programs), CAP (copay assistance programs) assisting clients in attaining the maximum plan and member benefits of such programs.
• Review, edit, maintain, and support the standard operating procedures for external advocacy companies that provide MSP (manufacturer savings programs), PAP (patient assistance programs), CAP (copay assistance programs), and assist clients in attaining maximum plan and member benefits of such programs.
• Support the standard operating procedures for clients that create and service pharmaceutical manufacturers regarding MSP (manufacturer savings programs), PAP (patient assistance programs), and CAP (copay assistance programs) where AMPS/Drexi is the back-end claims processor for such claims.
• Facilitate the appropriate claim migration and utilization of international drug sourcing for clients that have adopted this strategy.
• Support clinical and financial review of multiple accounts; develop a positive working relationship with all client touchpoints when and where necessary.
• Focus on ensuring we maintain superior customer service levels, operational excellence and strategic insight.
• Support new business implementations.
• Maintain account activity within the CRM system.
• Closely coordinate with Marketing, Product, and Sales areas on applicable initiatives as directed by leadership.
• Other training and project initiatives as directed and assigned by leadership.

Skills/Abilities:

• Excellent verbal and written communication skills
• Strong understanding of the PBM industry required.
• Strong data management experience and skills preferred.
• Healthcare, health plan, ERISA self-funded employer, and TPA experience preferred.
• Excellent customer service skills
• Strong analytical and problem-solving skills
• Confident decision-making abilities
• Detail-oriented, flexible, and strong organizational skills
• Ability to work independently and within a team environment.
• Ability to travel on an as-needed basis

Education/Experience:

• Bachelor's Degree or PharmD (preferred) degree from an accredited US School of Pharmacy
• Current Pharmacy License in good standing with the state that has issued that license
• Minimum of 5 - 7+ years pharmacy experience within the PBM or Managed Care industry

Physical Requirements:

• Commensurate with position/as defined by HR