Clinical Pharmacist II
Job Description:
- Manage Part D Coverage Determinations, Appeals, and Grievances: Apply clinical expertise, plan benefits, and CMS regulatory requirements.
- Lead Targeted Provider and Member Outreach: Conduct clinical outreach to prescribers, pharmacies, and members.
- Deliver Medication Therapy Management Services and Quality Initiatives: Perform comprehensive and targeted medication reviews.
- Manage Benefit Build and Member-Facing Materials: Assist with annual pharmacy benefit build activities.
- Oversee PBM delegated operations and Regulatory requirements: Ensure compliance with contractual and CMS requirements.
Requirements:
- Minimum of 3 years of pharmacy experience at a health plan, Pharmacy Benefit Manager (PBM), or managed care organization.
- Demonstrated experience conducting MTM or equivalent clinical pharmacy programs with documented member outcomes.
- Bachelor's degree in Pharmacy or a related health science discipline.
- Active and unrestricted Pharmacist license in the applicable state(s).
Benefits:
- Health insurance
- Retirement plans
- Paid time off
- Flexible working arrangements
- Professional development