About this role

Conduct clinical evaluations of medication therapy and review prior authorization requests using PDL criteria
Facilitate peer-to-peer discussions with providers regarding prior authorization decisions
Collaborate with prescribers and internal teams on clinical consultations and targeted interventions
Support call center operations by providing clinical guidance and assisting with provider/member communications
Serve as a subject matter expert for pharmacy-related questions across the organization
Contribute to quality improvement initiatives and program enhancements
Maintain clinical expertise and collaborate with cross-functional teams on pharmacy best practices
Provide input on drug utilization reviews and formulary management
Support Medicaid Drug Rebate Program operations and assist with state pharmacy audits
Deliver training to pharmacy providers and contribute to reporting and administrative activities

Registered Pharmacist with respective State Licensure
PharmD (preferred) or Bachelor of Pharmacy degree
At least 5 years of experience working in a pharmacy setting or pharmacy benefit management system
Knowledge of Medicaid at the state and/or federal level
Knowledge of pharmacy-related aspects of Medicaid
Working knowledge of HIPAA regulations and requirements.

Clinical Pharmacist Advisor

Key skills