Clinical Pharmacist

Daily Responsibilities for Clinical Pharmacist:  

• Position Purpose: Define and develop standard and custom formularies for assigned plan

• Develop clinical criteria for review of medications, recommend plan design changes and communicate recommendations to clients

• The pharmacist will be dedicated to our MMP (Medicare) line of business they will need to be aware of all **Formulary changes but not doing the filing or maintenance. They will be cross trained to support the Medicaid line of business so they will have working knowledge of how to do the **Prior Authorizations 

• Monitor and review prior authorization requests for medications

• Develop and design clinical edits to adjudicate claims and enhance drug utilization

• Analyze pharmacy cost of care, trends, and coordinate the development of appropriate use protocols and guidelines

• Set criteria for medication analysis, coordinate reports to clients, meet regulatory reporting requirements for drug utilization review and fraud and abuse reporting

• Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews

• Participate in the development and implementation of medication therapy management programs

• Provide clinical guidance and support to various departments and address clinical related questions