Pharmacist

• Acts as a liaison between Finance, Analytics, IT and Pharmacy
• Focus on understanding data content and the business logic behind all data transformation for reporting
• Develop expertise in the data and systems leveraged internally and externally for the Pharmacy Department
• Gather requirements, perform analysis, support the development and testing of processes
• Understand and document the applications, data and associated technologies for the Pharmacy Department

Senior Pharmacy Performance Specialist

• Demonstrates comprehensive knowledge of current pharmacotherapeutic principles, medical terminology, pathologies, disease state and population management, age appropriate therapy, and other information as related to medical and/or pharmaceutical care management.
• Work with Sentara Health Plan (SHP) members to close medication-related gaps in care
• Work on the referrals from the team
• Counseling members on their medication therapy

Clinical Pharmacist – Medicare STARS

• Understand and adhere to the National EMR Policies and Procedures Manual, Uniform Handbook, and Operations Manual.
• Foster a culture that encourages team members to work safely, identify potential hazards, and report safety concerns immediately to their direct chain of command.
• Maintain active status within the agency’s platforms, including learning management systems to complete training that may be directed toward self-improvement, mission-specifics, or Just-In-Time (JIT) training.
• Execute assigned pharmacy services for the service population as prescribed by an advanced practice provider or physician and apply best practice guidelines to include but not limited to medication inventory, storage, distribution, and documentation.
• Communicate effectively with health care providers regarding care for service population and be a liaison between pharmacy and medical staff.
• Maintain adequate inventory of all medications/supplies, ensure medications/supplies are within date and properly stored.
• Dispose of all unused and expired medications properly according to established protocols.
• Maintain electronic/paper medical health care records as determined by event/deployment.
• Develop and maintain an accurate medication administration record (MAR) for each client.
• Assist in daily MAR audits, ensuring proper documentation. Reporting all medication errors utilizing chain of command.
• Compile daily medical lists and distribute to all designated staff.
• Maintain first aid kits per licensing standards, if applicable.
• Assist in medication intake/discharge process in collaboration with other medical staff.
• Other duties as assigned.

Pharmacy Technician

• Responsible for support and input to clinical programs such as: Health Management, Drug Utilization Review, Formulary development, and Prior Authorization programs to encourage appropriate, high quality, cost effective drug therapy; and to identify opportunities for improvement in efficiency, accuracy, and appropriateness of the programs in place
• Participate in the Coverage Determination (Certification, Prior Authorization, Medical Exception, Exception to Coverage, etc.) process by reviewing all requests which are not clearly approvable based on specified criteria (algorithms), making all coverage denial determinations, and identifying themselves by first name, title, and responsibility at Navitus in relation to drug utilization management program administration
• Continually 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
• Complete all annual URAC training requirements
• Facilitation of communication and education to clients, members, and internal staff regarding clinical daily issues and objectives
• Provide support to operational departments on the implementation of various PBM programs and daily functioning in support of member/patient quality of care
• Responsible for supporting / providing clinical expertise related to formulary decisions made by the Pharmacy and Therapeutics committee
• May review health care survey data for Medicare Part D qualified participants and/or perform phone consultations with Med-D enrollees; aid in documentation of calls; designate enrollees for repeat interaction
• Other duties as assigned

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Senior Pharmacy Performance Specialist

Clinical Pharmacist – Medicare STARS

Pharmacy Technician

Pharmacist I – Clinical Prior Authorization