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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managed care pharmacy, including clinical utilization management, drug information support, and compliance with state and federal regulations. Proficient in synthesizing clinical data and collaborating with healthcare professionals to optimize pharmaceutical utilization.
Highest-signal resume keywords
Managed Care Pharmacy ExperienceClinical Utilization ManagementRegistered Pharmacist (RPh)Pharmacy and Therapeutics (P&T) ExperienceClinical Data Validation
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Pharmaceutical SelectionClinical Data ResearchDosage ConversionDrug Utilization Review (DUR)Clinical Criteria DevelopmentDrug Monograph PreparationClinical Evidence SynthesisDrug Pipeline MonitoringCross-Mapping Clinical CodesOptimizing Drug-Utilization Screening Rules
Soft Skills
CollaborationPresentation SkillsCommunication
Tools & Technologies
Medi-Span Database
Certifications & Qualifications
Registered Pharmacist (RPh)PharmD Preferred
Industry Keywords
Pharmacy and Therapeutics CommitteeClinical OperationsUtilization Management EditsState and Federal MandatesPrior AuthorizationStep TherapyQuantity Limitations
About the role
Key responsibilities & impact- Manage the selection and utilization of pharmaceuticals
- Support clinical utilization management programs including prior authorization, step therapy, and quantity limitations
- Research and synthesize detailed clinical data related to pharmaceuticals
- Prepare and present therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee
- Serve as a clinical resource to other pharmacists on prospective, inpatient, and retrospective DURs
- Provide dosage conversion and clinical support for therapeutic interventions
- Lead development and maintenance of clinical criteria for drugs processing on pharmacy and medical benefits
- Research and synthesize clinical evidence related to the efficacy and safety of drugs and biologics
- Review clinical evidence and guideline recommendations to create and maintain clinical utilization management edits
- Prepare and present drug clinical criteria through the quarterly Pharmacy and Therapeutics process
- Work with clinical operations teams to ensure claims system setup and clinical review algorithms are in place
- Present and collaborate with medical directors, pharmacists, nurses, and business area leads
- Provide drug information support to internal stakeholders
- Serve as a clinical pharmacy resource to pharmacy account management and trend management teams
- Ensure pharmacy utilization management edits comply with state and federal mandates and contractual agreements
- Monitor and evaluate the drug pipeline
Requirements
What you’ll need- Requires BA/BS in Pharmacy
- Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience
- Any combination of education and experience providing an equivalent background
- Requires a registered pharmacist
- Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh)
- PharmD preferred
- Residency and experience with Pharmacy and Therapeutics (P&T) preferred
- Experience in cross-mapping clinical codes highly preferred
- Experience optimizing drug-utilization screening rules highly preferred
- Experience validating clinical data accuracy using the Medi-Span database highly preferred
- Candidates must reside within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law
- New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless an acceptable explanation is provided
Benefits
Comp & perks- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short and long term disability benefits
- 401(k) +match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Hybrid work flexibility
- Potential COVID-19 and Influenza vaccination support/requirements for certain roles