Clinical Review Pharmacist

QUALIFICATIONS:

REQUIRED:

Must be a graduate from an accredited college of pharmacy and licensed as a pharmacist in the state of Minnesota

Must maintain this license in good standing as required by Minnesota law

Must meet one of the following:

Pharm.D.

One year of recent experience in a managed care pharmacy setting

One year of recent clinical pharmacy experience that includes prior authorization experience

Demonstrated knowledge of pharmacodynamics, and pharmacokinetics, pathophysiology and therapeutic disease states commonly found in ambulatory patients

Demonstrated competency in all professional aspects of pharmacy

Strong leadership and organizational skills. Maturity and dependability are essential

Ability to organize and function under stress with many interruptions

Ability to establish and maintain effective, friendly and courteous working relationships with coworkers, physicians and patients

Strong communication / listening skills and good telephone etiquette

Ability to accept and implement change

Ability to tactfully resolve complaints

PREFERRED:

Experience working with pharmacy technicians

Experience working with Microsoft suite of products

Knowledgeable in CMS and DHS regulations as well as other compliance related rules and entities

PHYSICAL REQUIREMENTS:

This position requires close visual perception and the ability to sit or stand for prolonged periods at a time. Must possess speech, hearing and sight skills to perform the functions of the position. Requires coordinated dexterity of hand, sensory acuity, and verbal ability. Must be able to speak, read and write English proficiently. Proficiency in other languages may be required.

POSITION PURPOSE:

Service excellence is to be centered on patient care and patient relationships and is the responsibility of all employees. Teamwork is the norm and all employees will be held accountable to work as effective team members. To review, approve and deny prior authorization requests in compliance with pharmacy policies, procedures, and standards. Provide support to physicians and pharmacy staff regarding prior authorization questions.

ACCOUNTABILITIES:

Review prior authorization requests for medical policy drugs (in clinic, home infused) and pharmacy benefit drugs; make coverage determinations for drug products according to member benefits and coverage criteria.

Contribute to the development, maintenance and communication of utilization management and exception criteria.

Provide clinical guidance and support to the Pharmacy Customer Service Assistants and other Pharmacy staff when requested.

Provide research and analysis of coverage determinations and appeals on an ad hoc basis.

Provide support and follow up for escalated clinical issues.

Research drug information to maintain drug knowledge and disease state understanding for application to drug coverage reviews.

Apply drug knowledge and evidence from literature to specific case situations, discussions with Medical Directors, and other peer review groups.

Provide effective drug information and consultation to professional staff, providers, patients and members.

Responsible for strict adherence to the requirements of CMS, DHS, MDH and other regulatory agencies.

Support and cooperate with other departments’ operation initiatives.

Maintain a professional image.

Adhere to the established Group Health, Inc., patient-service standards.

Perform other duties as assigned.

We’re a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.

At HealthPartners, everyone is welcome, included and valued. We’re working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.

Benefits Designed to Support Your Total Health
As a HealthPartners colleague, we’re committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.

Join us in our mission to improve the health and well-being of our patients, members, and communities.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.