Clinical Pharmacist- Prior Authorization Drug Request Adjudication

Job Title

Duties

Major Duties: A. Prior Authorization Drug Request (PADR) Reviews:

• Critically reviews all PADRs, facility wide (internal and CCN), for appropriateness.
• Implements and applies the VA formulary, guidelines, and restrictions to all PADRs being adjudicated.
• Understands, reviews, and applies criteria for use for each requested drug as appropriate.
• Reviews, analyzes, and applies the available medical literature as it pertains to PADRs and their adjudication.
• Seeks to provide patients with the best drug therapy possible while balancing drug availability and cost.
• Interfaces and communicates with providers, pharmacists, procurement and other staff, as needed, providing input and feedback before, during, and after the adjudication process for requested drugs.
• Coordinates with clinical pharmacists when reviewing, commenting on, and adjudicating CCN PADRs (entered by clinical pharmacists).
• Acts as a reference to pharmacists and providers in answering questions about the formulary status and requirements for obtaining nonformulary or restricted drugs.
• Actively participates in formulary, restricted, and non-formulary usage discussions to promote evidence-based, cost-effective drug therapy.
• Promotes compliance with the VHA National Formulary and clinical guidelines in the Health System.
• Provides consistent oversight of prior authorization reviews allowing for equal care amongst patients seen at the facility as well as via community care.
• Assists in conducting and reporting internal audits as required. Maintains all pertinent professional and administrative records as necessary. Assists in data collection for drug utilization evaluations and adverse drug events.
• Acts as a liaison between Pharmacy Service and other health care providers.
• Performs other duties as assigned.

Work Schedule: Non-compressed tour (8 hours) between the hours of 6 AM - 6PM; Every other weekend. Tour may be adjusted to meet medical center and patient care needs

Telework: Ad Hoc

Virtual: This is not a virtual position.

Functional Statement #: 942600

Relocation/Recruitment Incentives: Not Authorized

Permanent Change of Station (PCS): Not Authorized