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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.
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
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
coverage determinationappeals processdrug utilizationpharmacy cost controlquality initiativesclinical guidelinesSTAR ratingsHEDISCAHPSutilization review
Soft Skills
communicationliaisoncollaborationproblem-solvingorganizational skills
Certifications
Doctorate of Pharmacy (PharmD)Pharmacy License