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Pharmacist I

Job Summary:

Pharmacist I is responsible for supporting the department, operational strategies, goals and vision. Pharmacists shall utilize pharmaceutical and clinical expertise to review Prior Authorizations requests within a timely manner, to promptly serve our CareSource members.

Essential Functions:

Supports and participates in Prior Authorization (PA) Reviews by documenting, implementing and utilizing the following: Formulary Management guidelines, Utilization Management programs, CareSource Administrative and Operational policies and procedures, and/or other clinical programs
Execute critical thinking and decision processes when evaluating PA Reviews for Pharmacy and Medical Benefit medications
Conduct PA Reviews for Multi-State Medicaid and Marketplace lines of business
Provide written communications to members and providers upon decisioning of PA requests
Engage Providers in “Peer to Peer” discussions, and Clinical Consults, as requested
Assist Pharmacy PA call center staff
Provide support and collaborate with pharmacy technicians to ensure operational efficiencies
Adhere to Turn Around Time (TAT) requirements, per Line of Business
Observe Operational Productivity Goals and Metrics
Maintain exceptional quality
Cross-collaborate with Departmental and Organizational Teams
Perform any other job duties as requested

Education and Experience:

Bachelor’s Degree in Pharmacy is required; Doctor of Pharmacy (PharmD) is preferred
Minimum of three (3) years of retail pharmacy experience is preferred
Minimum of one (1) year managed care or Medicare experience is preferred

Competencies, Knowledge and Skills:

Working knowledge of Microsoft Outlook, Teams, Word, Excel, and PowerPoint
Familiarity with the healthcare field, including Insurer, PBM, Specialty or Retail Pharmacy and Provider
Understanding Managed Care and/or Retail Pharmacy operations with respect to Medicaid, Marketplace and /or Medicare
Proficient in medical terminology, medication names, generics and biosimilars
Application of Clinical guidelines, policies, and decision trees/tools
Understanding the pharmacist’s clinical role in the care of members; utilization of Clinical expertise
Strong written and verbal Communication skills, including use of proper grammar in print and e-mail communications
Ability to simplify clinical language for lay persons
Critical listening, thinking and problem-solving skills
Attention to detail
Organized and learns quickly
Comfortable working in a fast-paced environment
Time management skills
Use of proper phone etiquette
Ability to work independently and within a team environment

Licensure and Certification:

Current, unrestricted Registered Pharmacist (RPh) licensure is required
Ability to acquire additional State License(s) in multiple states, as required

Working Conditions:

General office or Remote work environment; may be required to sit or stand for extended periods of time

Compensation Range:

$94,100.00 - $164,800.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies