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Posted: 12-Nov-24
Location: San Antonio, Texas
Salary: Open
Categories:
Internal Number: 144299397
WellMed, part of the Optum family of businesses, is seeking a Clinical Pharmacist - Prior Authorizations to join our team in San Antonio, TX. Optum is a clinician-led care organization that is changing the way clinicians work and live.
As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone.
At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.
Under general supervision of the Director of Clinical Pharmacy, the Clinical Pharmacist is responsible for conducting prior authorization reviews on Part B Specialty/Oncology medications, performing comprehensive and targeted medication management in selected patients to identify, resolve, and prevent medication-related problems as needed for WellMed Managed Care Patients. The Clinical Pharmacist will work with various roles like Nurses, Pharmacy support specialist on day to day basis along with primary care providers and other pertinent health care team members. The Clinical Pharmacist is also focused on achieving optimal use of medications, emphasizing dosing, monitoring, identification of adverse effects, and economic efficiency to achieve optimal patient outcomes.
If reside and be a licensed pharmacist in Texas, you will have the flexibility to work remotely* as you take on some tough challenges. Will travel to San Antonio once a quarter
Primary Responsibilities:
- Completes assigned daily cases by processing prior authorization and medical necessity requests for specialty CMS part B medications and meet production, performance metrics as determined by the department in order to comply with CMS Part B turnaround times (TAT)
- Review specialty medication prior authorization requests (i.e. biopharmaceuticals) according to established treatment protocols, clinical criteria and member benefits and make determinations within the defined turnaround times to meet regulatory requirements
- Conduct comprehensive medication reviews for select patient population and collaborate with prescribers and other members of the care team to resolve identified medication-related problems
- Assist with oversight of medication management activities in employed clinics across the enterprise, in collaboration with the market nurse leadership, to meet state and federal regulations
- Provide clinical recommendations, in alignment with evidence based guidelines, pertaining to, but not limited to, gaps in care, high risk medications, compliance and adherence, drug interactions, therapeutic substitution, and generic substitution to both patients and/or providers
- Actively maintain knowledge of current and emerging clinical trends to assist with the development of Clinical Practice Guidelines
- Active participation in various clinical departmental meetings and forums to improve clinical programs, enhance processes, and share clinical information
- Research new prescription drugs or new applications of existing drugs, develops drug use guidelines and communicate findings to providers
- Utilizes available prescription/medical data, health plan’s formulary and clinical judgement to perform comprehensive medication reviews, retrospective Drug Utilization Review (DUR) to optimize ongoing medication treatments plans for patients/providers and reducing overall cost burden to the health system
- Assist with user acceptance testing for new clinical programs and system enhancements
- Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practice specific to specialty pharmacy
- Serves as a clinical resource and consultant in all areas of pharmacy and medication management for members, patients, providers, internal departments, and/or external third parties
- Supports overall Enterprise Care &Value department initiatives
- Follow all policies and procedures related to job
- Performs all other related duties as assigned to meet departmental objectives
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- Doctor of Pharmacy degree
- Current Pharmacist license to practice in the applicable state
- 2+ years of experience as a Prior Authorization Pharmacist or Clinical Pharmacist, conducting such activities as medication therapy management, clinical rounds, disease state management, etc. Relevant experience includes ANY of the following or a combination thereof:
- Retail pharmacy
- Pharmacy Benefit Management
- Infusion or hospital pharmacy experience
- Proven excellent written and verbal communication skills
- Proven excellent relationship building skills
- Proven solid analytical and PC operation skills
- Willing or ability to travel as necessary (local, 25%)
Preferred Qualifications:
- Board certification by the Board of Pharmacy Specialties (BPS)
- Certified Geriatric Pharmacist
- Certification in Medication Therapy Management (MTM)
- Experience with Medicare guidelines
- Experience working in a metric-driven environment
- Demonstrated ability to obtain additional pharmacist licensure based on business needs
- Proven planning and organizational skills to demonstrate leadership and initiative
Physical & Mental Requirements:
- Ability to lift up to pounds
- Ability to push or pull heavy objects using up to pounds of force
- Ability to stand for extended periods of time
- Ability to use fine motor skills to operate office equipment and/or machinery
- Ability to properly drive and operate a company vehicle
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
