- Act as a clinical expert on prior authorization review and evaluation in accordance with clinical criteria and covered plan design.
- Review, evaluate, and resolve all assigned clinical reviews through comprehensive case review and highlight our Population Health Management model with direct physician engagement.
- Subject matter expert on the EmpiRx Health Population Health Management Model
- Review and evaluate clinical literature resources to support decision-making and recommendations to providers.
- Monitor and proactively identify clinical interventions to ensure clinical savings guarantees are met.
- Perform peer-to-peer reviews with providers on identified cases or when requested.
- Provide guidance and support to members, providers, and other healthcare providers on clinical-related inquiries.
- Collaborate with clinical technicians, prior authorization team members to facilitate clinical review requests, answer questions and/or resolve escalations.
- Convey clinical determinations promptly within established turnaround time requirements to prescribers, members and other healthcare professionals following agreed-upon approval, denial processes.
- Participate in continuous quality improvement efforts to streamline the clinical review process and enhance member care.
- Stay updated with changes in pharmacy practice and industry regulations through continuing education and professional development.
- Stay informed about EmpiRx Health formulary changes, clinical programs, and internal policies.
- Act as a clinical resource for internal staff and support staff training/development as required.
- Proficiently utilize pharmacy management software for documentation and communications.
- Proficiently utilize Microsoft Office tools.
- Utilize external clinical and drug information tools to support clinical reviews and decision making as well as to stay abreast of current drug pipeline (e.g., IPD, Policy Reporter, UpToDate, and MediSpan)
- Collaborate with internal clinical team and cross-functional teams to provide clinical support and guidance, as needed, including but not limited to claim/data review, clinical interventions, and provider/member/client support as required.
- 3+ years of pharmacy experience
- PharmD (required)
- Active pharmacist license
- Exceptional written and verbal communication skills
- Experienced in Microsoft Office Suite; prescription medication analysis.
- PBM/Health Plan experience evaluating and reviewing Prior Authorization preferred
- Specialty Pharmacy experience preferred
- MTM certification or other specialty certifications preferred
- EmpiRx Health is on an extraordinary journey where excellence meets innovation.
- We are a collaborative team that encourages groundbreaking ideas, values open dialogue, and prioritizes continuous improvement.
- You will be part of a dynamic team where success is a shared celebration, collaboration fuels progress, and we redefine healthcare together.
- We offer a generous and competitive benefits package.
- You will share in the company's success through our discretionary bonus program.
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Clinical Pharmacist - Montvale, United States - EmpiRx Health
Description
Who We Are:EmpiRx Health is the leading clinically-driven, customer-first PBM company that puts the pharmacist at the center of its service model to optimize member care while substantially reducing costs for plan sponsors.
What We Do:
We place more emphasis on member care than any other PBM by focusing on health outcomes first. Our pharmacists and clinicians are at the center of everything we do-and our population health solution delivers tailored strategies for our clients.
Who We're Looking For:
EmpiRx Health is expecting unprecedented growth, and we're seeking a highly skilled and experienced Clinical Pharmacist. In this critical role, you will ensure clinical prior authorization and appeal determinations in accordance with covered plan design while ensuring clinically appropriate pharmacy care and deep and sustainable clinical savings for our clients.
If you are a highly motivated Clinical Pharmacist with a strong background in comprehensive case review and direct physician engagement, and you are passionate about making a meaningful impact in the healthcare industry, we encourage you to apply.
What You'll Do:
As a Clinical Pharmacist, your role will encompass a wide range of responsibilities:
At EmpiRx Health, we wholeheartedly embrace the power of diversity and the magic of inclusion. The kaleidoscope of unique perspectives, backgrounds, and talents fuels our innovation and sets us apart. We're not just breaking down barriers but actively erasing them to create an environment where opportunity knows no bounds. In unity, we find our strength and invite individuals from all walks of life to join us in our exhilarating journey to shape a brighter, more inclusive future together.
Your career at EmpiRx Health awaits - join us in shaping the future of excellence in healthcare.
