Medicaid Pharmacist (Clinical Pharmacist)
The Medicaid Clinical Pharmacist reviews pharmacy prior authorization requests for Health Choice beneficiaries by utilizing appropriate application of clinical criteria for prescription and medical (J-codes) drug services for various Health Choice pharmacy plans. The Medicaid pharmacist will assist health plan pharmacists maintain clinical criteria for medication coverage consistent with regulatory requirements and evidence-based clinical practice, review requests for prescription and medical drug services for member cases, and work to meet performance metrics associate with the prior authorization processes. This includes but is not limited to PA case turnaround times, maintaining case review quality standards, case decision integrity, and clinical operations best practices.
Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment - while still being valued for your individual strengths - Health Choice is the place for you.
Equal Opportunity Employer Minorities/Women/Veterans/Disabled
Pharmacy degree from an accredited College of Pharmacy, PharmD preferred
At least five (5) years of practice experience with a health plan pharmacy services, managed care environment, and / or retail or hospital pharmacy service
At least two (2) years of practice experience in developing and applying clinical drug use criteria
Proficient in the principles and practices of managed care pharmacy
Broad-based knowledge in a variety of pharmacy disciplines
Knowledge of Medicare and Medicaid regulations and guidelines regarding coverage determinations
Knowledge of peer-reviewed literature for production of PA Criteria Guidelines
Knowledge of drug options for the appropriate clinical management of member medical conditions
Arizona state Pharmacist license in good standing
Current Arizona driver's license, reliable transportation, and current insurance coverage required