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Clinical Pharmacist - Prior Authorization

WellDyneRx, Inc., was founded in 1990 and offers pharmacy benefit management services to its health plan members through a retail network of pharmacies; patient care services to members who require support in managing their chronic conditions; pharmacy mail service solutions; and technology network administration solutions for retail pharmacies.  With over 350 employees in two state-of-the-art locations in Centennial, CO and Lakeland ,FL, WellDyneRx is experiencing tremendous growth in the pharmacy and health care industries. Clients include managed care organizations, Medicare and government health plans, third party administrators, unions, and self-insured employers, including state and local governments.  WellDyneRx has a wide range of expertise, from full pharmacy benefit management services and innovative health and wellness programs, to specialty and mail order pharmacies.

Our people are our greatest asset, and it is their commitment to providing remarkable customer support and innovative health care solutions that has driven WellDyneRx’s success. WellDyneRx  is focused on developing our employees, understanding that our future success depends on the talent we hire today. The WellDyneRx culture is grounded in its core values that include:

•             Client and Member Focus – Our customers are the reason that we are here. We work to provide access to pharmaceuticals for our members with a high-touch service mindset, while minimizing drug costs for our clients. We are in the business of service.

•             Accountability – We take responsibility for our own actions and decisions; we meet our commitments.

•             Communication – We will work as a team, and will establish effective, open communication channels among all relevant parties. No silos. We will ensure effective communication of mission and goals.

•             Candor – We provide straightforward answers and feedback, even if the news is bad. We pride ourselves on our honesty and our integrity.

•             Entrepreneurial Spirit – We operate with a “can-do” attitude. We roll up our sleeves and get the job done. We seek to change the organization for the better.

•             Compliance: Ensure the company complies with laws, regulations, agreements and accreditations that allow the business to operate successfully and meet the needs of our customers.

WellDyneRx is the perfect place for people with an entrepreneurial spirit who are fulfilled by delivering consistent, quality results and service to both internal and external customers. Come be a part of this exciting time in WellDyneRx’s  20-year history and find a career you can grow with. Join Our Team.

Summary

The Clinical Prior Authorization Pharmacist performs prospective and/or retrospective drug utilization reviews and appeals in accordance with internal pharmacy coverage criteria guidelines, and state and federal regulations. The PA pharmacist shall assist the Clinical Operations Pharmacist team create and update clinical criteria for medication coverage consistent with regulatory requirements and evidenced-based clinical practice, review requests for prescription drug services, and work to improve performance metrics associated with the prior authorization processes.

Essential Duties & Responsibilities

  • Review medication prior authorizations for therapeutic appropriateness
  • Assist in implementation of clinical programs and outcomes (e.g., adherence programs, disease specific care management, medication reconciliation, etc.)
  • Communicate with key departments to support WellDyneRx clients and members
  • Serve as a drug information resource for internal and external customers
  • Collaborate with key WellDyneRx departments, providers, pharmacies and members to resolve any issues or questions involving prior authorizations
  • Serve as a resource for the Help Desk Technicians and Level II Technicians for PA-related questions and issues with claim-processing software
  • Identify opportunities for improvement in efficiency, accuracy and appropriateness of the programs in place
  • Continuously monitor the quality and efficiency of the Coverage Determination process, including coverage criteria, denial language and communication with prescribers
  • Provide input to clinical content of new programs and for maintenance of existing programs
  • Participate in multi-departmental meetings and committees to accomplish projects
  • Responsible for remaining current with clinical literature and guidelines
  • Adhere to all applicable company policies and procedures
  • Perform other duties as requested

Job Requirements

  • Clinical pharmacist experience with pharmacy practice guidelines; review of formulary programs, pharmacoeconomics; or pharmacy quality improvement processes/techniques
  • Knowledge of medication use evaluation principles
  • Drug information skills
  • Analytical skills
  • Effective verbal and written communication skills
  • Skills to handle multiple priorities and manage communications professionally to achieve issue resolution with customers, employees or management

Basic Qualifications

  • Bachelor’s or Doctor of Pharmacy degree obtained from an accredited college or university
  • Active pharmacist license in good-standing in state of practice
  • Knowledge of PBM industry, pharmacy claims, and managed care principles
  • Exceptional clinical skills and ability to apply sound clinical judgement to a variety of situations
  • Minimum five years pharmacy practice experience

Preferred Qualifications

  • Clinical or managed care pharmacy practice residency experience
  • Proficiency in drug literature and clinical trial evaluation, including proficiency with electronic databases
  • Experience developing and implementing system tools

Work Environment/Physical Demands

This position is a typical office environment which requires prolonged sitting in front of a computer:

Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment, including operation of standard computer and phone equipment

May have occasional high stress when dealing with customers/clients

Travel may be required

 

EOE M/F/D/V

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