Pharmacist(000554)

Duties:
Reviews Medical drug prior authorization and appeal requests for all LOBs then renders coverage determinations based on MetroPlus preferred drug strategies, available benefits, internal criteria and clinical judgement
Assists in responding to internal/external inquiries related to prior authorization review including weekends and holidays
Assists in identifying inappropriate utilization during claims and prior authorization review
Performs audits as necessary of vendor or internal reviewed cases to ensure all clinical, organizational and operational standards have been met
Completes medication reviews for MetroPlus members to ensure safe and efficacious therapy
Assists in organizational and departmental quality improvement initiatives
Responds to pharmacy benefit related inquiries
Participates in Quarterly Pharmacy and Therapeutics (P&T) meetings
Creates and reviews prior authorization criteria for medications as needed

Skills:
Required Skills & Experience:
One (1) year of Pharmacist experience.

Preferred Skills & Experience:
Pharmacy dispensing system experience.
Sterile Processing experience.
IV room experience.
Knowledge of an EMR (Electronic Medical Records system) preferred.

Doctor of Pharmacy required
Clinical pharmacy experience and utilization management experience in a managed care environment preferred
Experience in Pharmacy management of government programs (Medicaid and Exchange) preferred
Proficiency with MS Word, Excel, and PowerPoint is required. Experience in the evaluation and interpretation of pharmacy claims data and other clinical data is preferred
Position requires excellent organizational, teamwork, interpersonal, time management, written and verbal communication skills

Education:
Required Education:
Bachelor's degree or higher in pharmacy.

Required Certifications & Licensure:
Valid license to practice as a Pharmacist issued by NYSED, Primary Source Verification required.

Preferred Certifications & Licensure:
N/A
Current New York State Pharmacy License (active and not limited).

Languages:
English: Read, Write, Speak

Certifications & Licenses:
Valid license to practice as a Pharmacist issued by NYSED, Primary Source Verification required.