Medical Drug Policy and Programs Clinical Pharmacist - Hybrid

• Maintain medical drug authorization system functionality to ensure appropriate application of clinical criteria and adherence to regulatory requirements of the medical drug authorization processes and outputs
• Establish medical drug reporting to demonstrate operational productivity, clinical decision outcomes and assessments, and compliance with regulatory requirements such as case turn-around times (TAT) and outreaches for information and decision notifications
• Implement, maintain, and enforce policies and procedures for member medical drug authorizations and service requests in accordance with accreditation, state and federal guidelines and requirements
• Serve as clinical reviewer for requests for medical drug services, appeals, expert opinion requests, and complex member cases
• Develop and maintain medical drug, and pharmacy drug use criteria and protocols in collaboration with health plan pharmacists
• Support health plan pharmacists and VP of clinical operations or CMO regarding clinical coverage criteria and criteria committee activities and decisions
• Create and maintain site for access of Medicaid Business Segment medical drug coverage criteria
• Assist with the provision of accurate Medicaid Business Segment medical drug and clinical criteria documents as well as notices to providers and members on medical drug coverage and clinical criteria changes
• Collaborate and communicate with interdepartmental staff and providers
• Educate Medicaid Business Segment staff on medical drug authorizations systems, application of clinical criteria, and case outcomes as well as maintain appropriate documentation of systems and criteria for audit purposes
• Serve as a clinical resource and role model for Medicaid Business Segment medical drug and pharmacy staff and employees
• Provide training to staff on medical drug authorization system operations as well as policies and procedures for member drug authorizations and service requests in accordance with accreditation, state and federal guidelines and requirements
• Develop and implement member and provider education materials on clinical topics which include but are not limited to medical drug PA grid, utilization management criteria, and tools for effective access to covered medications
• Provide staff training on medication related topics that assists pharmacy staff in understanding the medication needs and concerns of our member
• Assist with the provision of activities associated with clinical programs that promote clinically appropriate and safe medication use
• Conduct clinical activities that satisfy and support regulatory requirements for safe and clinically appropriate medical drug services which includes but is not limited to member drug therapy reviews, provider drug prescribing or dispensing reviews, high-cost medication trend reviews, and medication reconciliations
• Oversee, conduct, and maintain medication therapy management activities that decrease over or under utilization of medications and improve member health through closing gaps in care and improving medication adherence
• Perform all other duties as assigned including but not limited to input of medical drug contracts, oversight of medical drug distributors and vendors, and medical drug claims issues
• The position requires a full-time work schedule

• 5 years of practice experience with a health plan pharmacy service, managed care environment, and/or retail or hospital pharmacy service
• 2 years of practice experience in developing and applying clinical drug use criteria
• Pharmacy degree from an accredited college of pharmacy
• Active, current and unrestricted State of Arizona (a state in the United States) pharmacist license

Doctor of Pharmacy (Pharm.D) degree