Consultant

• Provides orientation, training, guidance and direction, to Consultant Pharmacists and Pharmacy Associates
• Coordinates the request for prior authorization (RPA) process including the data entry and the generation of reports that stem from this process, as well as ensure compliance with the federal twenty-four hour time limit
• Participates in program planning and development
• Participates in the development of clinical drug use criteria for the prospective and retrospective review components of the DUR Program
• Researches member’s case and may represent the client during appeal processes regarding prescription medications
• Performs medication therapy management comprehensive and targeted medication reviews of medical and medication profiles
• Reviews member’s medical and medication profiles and interacts with health care providers and client members to review appropriate drug therapy
• Provide real-time drug therapy recommendations to prescribers
• Reviews clinical documentation submitted by treating physicians and pharmacists to determine medical necessity and program compliance
• Decides in real time via telephone communications with pharmacies the authorization or denial of prior approval requests for prescription medications
• Provides pharmaceutical expertise and knowledge to the advisory board’s clinical workgroups
• Monitors over-utilization and under-utilization of prescribed medicines for members
• Assists in monitoring and researching profiles for compliance on a daily basis
• Refers suspected abuse and fraudulent members to the program manager or designee for case review
• Participates in site visits to Provider offices, as necessary
• Participates in agency meetings as requested
• Leads and participates in quality improvement and quality assurance initiatives

Consultant Pharmacist IV

Medicaid Eligibility Consultant II