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Clinical Review Pharmacist – Contractor
ChenMedClinical Review Pharmacist reviewing medication directives and ensuring compliance at ChenMed. Engaging in formulary management and clinical pharmacy services for quality patient outcomes.
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
coverage determinationappeals processdrug utilizationpharmacy cost controlquality initiativesclinical guidelinesSTAR ratingsHEDISCAHPSutilization review
Soft Skills
communicationliaisoncollaborationproblem-solvingorganizational skills
Certifications & Qualifications
Doctorate of Pharmacy (PharmD)Pharmacy License
Industry Keywords
managed careHMOMSOPBMMedicare Part DMedicaidpharmacy benefitsquality metrics
About the role
Key responsibilities & impact- Reviews coverage determinations and appeals in a timely, compliant, and accurate manner.
- Ensures compliance with the coverage determination and appeals process.
- Acts as a liaison between ChenMed and its patients with respect to the clinical guidelines we practice.
- Serves as the formulary expert for the therapeutic class they are reviewing.
- Contributes to projects aimed at improving STAR ratings, HEDIS, CAHPS, and other quality metrics.
- Assists with clinical questions and phone calls from prescribers, pharmacies and/or ChenMed members.
- Develops, implements and maintains pharmacy cost control and quality initiatives under the direction of leadership and guidelines.
- Monitors drug utilization and assists Pharmacy leadership team in understanding quality and cost control issues.
- Acts as a liaison between ChenMed and its members with respect to the pharmacy benefits.
- Works with providers to ensure accurate coverage determination decisions.
- Performs outreach to patients and providers as part of quality and/or cost control initiatives.
- Performs other duties as assigned and modified at manager’s discretion.
Requirements
What you’ll need- Doctorate of Pharmacy (PharmD) required
- Must have a License that is in good standing
- Minimum one (1) year of pharmacy experience
- Minimum one (1) year of utilization review experience preferred
- Pharmacy residency training is preferred, but not required
- Experience in a managed care setting (HMO, MSO, PBM) is a plus
- Medicare Part D or Medicaid experience, along with managed care experience
Benefits
Comp & perks- great compensation
- comprehensive benefits
- career development and advancement opportunities
- work-life balance