Position Overview
This position involves the development of pharmacy policy and direct interaction with medical and pharmacy providers, agency personnel, and the public regarding these policies.
Key Responsibilities
Policy Development & Operations
- Develop pharmacy policies and collaborate with the fiscal agent to ensure claims are processed according to established policies, and that system data is reported correctly and made available for program management.
- Work with the Rational Drug Therapy program to implement established policies and provide information for other department task forces upon request.
- Collaborate with the pharmacy director to implement, maintain, and manage the Preferred Drug List (PDL), including reviewing changes and recommendations from the PDL vendor.
Board Support & Clinical Review
- Provide staff support and oversight for quarterly meetings of the Drug Utilization Review (DUR) board and monthly meetings of the retrospective DUR committee.
- Develop criteria for the appropriate utilization of drugs and review member profiles to ensure that criteria are developed for all appropriate therapeutic classes and that current treatment guidelines are employed.
Communication & Inquiry Management
- Interact with Medicaid providers, other departments, and pharmaceutical company representatives to explain established policies.
- Manage inquiries, averaging 90 calls per month, most of which require a written response (such as a follow-up letter or email).
Program Oversight & Fraud Prevention
- Oversee the pharmacy lock-in program for Medicaid members who may use or divert controlled substances.
- Establish policies to control the inappropriate use of controlled substances.
- Partner with Medicaid fraud, surveillance and utilization review units (SURS), and Medicaid providers to minimize overutilization and the diversion of drugs supplied by the Medicaid program.
Other Duties
- Perform other duties as assigned.
Minimum Qualifications
Training: Certificate of registration as a pharmacist issued by the West Virginia Board of Pharmacy.
Experience: Four years of full-time or equivalent part-time paid experience as a pharmacist, two of which have been in a supervisory or administrative capacity.
#INDHP
Job Type: Full-time
Pay: $78,448.00 - $117,665.00 per year
Benefits:
- Dental insurance
- Employee assistance program
- Employee discount
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Tuition reimbursement
- Vision insurance
Experience:
- pharmacist: 4 years (Required)
License/Certification:
- Certified Pharmacist (Required)
Ability to Commute:
- Kanawha County, WV (Required)
Work Location: In person
