Clinical Pharmacist

Overview

• Provide clinical pharmacy services to Medicare members, enhancing medication adherence and addressing gaps in care.
• Conduct Comprehensive Medication Reviews (CMRs) to improve understanding of medications and health management.
• Collaborate with providers and pharmacies to resolve adherence issues and optimize care.
• Offer counseling and guidance on medication use and pharmacy benefits.
• Support Pharmacy Quality Specialists with clinical expertise and recommendations.
• Review prior authorization requests ensuring compliance with member benefits and coverage criteria.
• Research and apply drug information to maintain knowledge for clinical reviews.
• Ensure quality controls and identify opportunities for performance improvement in pharmacy practices.

Key Responsibilities & Duties

• Engage Medicare members to address adherence gaps and provide medication counseling.
• Collaborate with providers to close Statin Use in Persons with Diabetes (SUPD) gaps.
• Perform CMRs to identify potential drug interactions and adverse reactions.
• Provide clinical guidance to Pharmacy Quality Specialists and pharmacy technicians.
• Review prior authorization requests and ensure compliance with guidelines.
• Track compliance and report utilization review statistics to committees.
• Research drug information to maintain expertise in disease states and medication reviews.
• Implement quality controls and performance improvement measures in pharmacy practices.

Job Requirements

• Doctor of Pharmacy (PharmD) degree required.
• Current state pharmacy license mandatory.
• Minimum of 3 years of clinical pharmacy experience; 5 years preferred.
• Knowledge of drug coding systems (NDC, GCN, GPI, USC) and NCPDP claims adjudication.
• Proficiency in prior authorization and non-formulary drug review processes.
• Strong analytical skills for evaluating pharmacy benefit designs and utilization review.
• Ability to provide clinical guidance to pharmacy teams and specialists.
• Excellent communication skills for member counseling and provider collaboration.