Clinical Pharmacist
Healthfirst · US
The Clinical Pharmacist is a dynamic position responsible for the review of prior authorization requests for medications requested under the medical benefit.
Job description
The Clinical Pharmacist is a dynamic position responsible for the review of prior authorization requests for medications requested under the medical benefit. Additionally, the Clinical Pharmacist will be responsible for developing clinical criteria, medical policies for provider administered medications, review of monthly report for quality assurance, and staying current with literature, evidence-based medicine, and trends in medicine. The Clinical Pharmacist will work directly with prescribing physicians and Medical Directors to discuss clinical rationale for review decisions. This position reports to the Director of Pharmacy. Duties & Responsibilities: - Monitor and review prior authorization requests for medications - Calculate appropriate billable units based on dosing based, indication, weight, BMI and other clinical considerations - Develop clinical criteria and medical policies for the review of medications - Ensure all clinical criteria is in compliance with Center of Medicare and Medicaid Services (CMS) and the New York State Department of Health (NYSDOH) - Research drug information to maintain drug knowledge and disease state understanding for application to prior authori...