Performs prospective and/or retrospective drug utilization review and appeals per State and Federal regulations. Participates in the distribution of clinical drug information and educates providers and staff regarding the use of pharmaceutical treatment regimens. Complies with all corporate and facility standard operating procedures, policies, guidelines, and work instructions.
Provides prior-authorization services for formulary drugs, develops programs to provide optimal pharmacy care to patients, participates in drug utilization review programs, reviews assessment and documentation of patient care, and retrospective reviews of provider reimbursement. Makes recommendations to physicians and other prescribers on medication regimens as per plan guidelines. Assists providers to ensure accurate dispensing and billing of products.
Collaborates with other clinical personnel in assessing treatment guidelines. May participate in formulary development and management. Supports the national Pharmacy and Therapeutics Committee. Validates the clinical availability of multi-source products for provider utilization.
Adheres to organizational policies and procedures. Ensures compliance with Federal and State laws and standards of practice which govern the profession of pharmacy. Maintains pharmacy records in accordance with all applicable state and federal laws and regulations. Maintains clinical skills and knowledge of pharmacotherapy by reviewing the literature, continuing education and any company provided in-services. Completes all mandatory company provided on-line courses. Attends and completes all employee development courses.
Participates in mandatory on-call rotation when required by business needs.
Makes outbound or takes inbound telephone calls to assist in various aspects of patient care and/or product distribution to/from practitioners, members, and pharmacies. These calls include, but are not limited to, comprehensive medication reviews, targeted medication reviews, call to practitioners about product awareness, and prior authorizations.
General Job Information
United States of America
United States of America (Exempt)
Recruiting Start Date
Date Requisition Created
Bachelors: Pharmacy (Required), PharmD: Pharmacy
License and Certifications - Required
RPH - Registered Pharmacist - Pharmacy
License and Certifications - Preferred
PharmD - Doctor Of Pharmacy, State Licensure - Pharmacy
Other Job Requirements
License must be current and in good standing.Strong drug product and clinical pharmacy knowledge.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled