FEP Clinical Pharmacist-3 years Managed Care experience required

Provide utilization and drug interaction of drug therapies to include review of prior authorization requests according to FEP member benefits and coverage criteria. Perform member specific interventions through provider collaboration and comprehensive medication review with a focus on cost savings, HEDIS measure gap closure, and reduction of readmissions.

REQUIRED QUALIFICATIONS

• 3 years or more as a practicing pharmacist
• 3 years or more experience in the managed care pharmacy field

Required Education

• Doctor of Pharmacy (Pharm.D) degree

Required Licenses

• Active, current and unrestricted State of Arizona (a state in the United States) pharmacist license

Required Certifications

• Specialty certification in Medication Therapy Management (may obtain certification within 6 months of job entry)

PREFERRED QUALIFICATIONS

• 5 years or more as a practicing pharmacist
• 5 years or more of experience in the managed care pharmacy field
• 2 years of experience with Medicare Part D formulary and utilization management
• 2 years of experience in performing Medication Therapy Management

Preferred Education

• N/A

Preferred Licenses

• N/A

Preferred Certifications

• N/A

ESSENTIAL job functions AND RESPONSIBILITIES

• Collaborate with FEP Management, FEP Operations, and FEP HEDIS to create clear communication to FEP members and/or network providers on medication therapy recommendations.

• Work in partnership with FEPDO and Pharmacy Management team.
• Regularly collaborate with other plan pharmacy reps and programs.
• Collaborate with FEP Management and HEDIS staff for targeted FEP ongoing initiatives.
• Act as a clinical resource to FEP internal staff regarding medication therapy.
• Evaluate medication related problems such as adverse events, therapeutic duplication, adherence to therapy, polypharmacy, and untreated disease or conditions.
• Analyzes, documents, and reports member outreach and intervention performance results as required by the FEP Medication Therapy Management Program (MTM Program).
• Provide education and training on the appropriate use of medications to monitor and evaluate patients response to therapy.
• Document all interventions via a medication related action plan or care plan (CP). The care plan is the course of action to achieve the specified health goals.
• Support and resolve pharmacy related member specific benefit issues.
• Utilize prescription and medical claim data to generate clinical recommendations according to Medication Therapy Management and Retrospective Drug Utilization Review program and protocols.
• Provide clinical recommendations pertaining to, but not limited to, gaps in care, high risk medications, compliance and adherence, drug interactions, therapeutic substitution, and generic substitution.
• Utilize client formulary information and member specific benefits to guide appropriate medication recommendations.
• Maintain awareness of current and emerging clinical trends including but not limited to specialty practice, diseases, published literature and medication therapies for specific patient populations to educate clinical team, physicians and other prescribers.
• Actively participate with cross functional team meetings to improve clinical programs, enhance processes and share clinical information.

• Maintain effective working relationships to ensure teamwork in achieving corporate goals.
• Participate in quality initiatives; including functions that support audits, reporting, evaluation of quality opportunities and concerns, and creation and implementation of corrective actions as requested.
• Coordinate activities between multiple divisions to achieve desired results.
• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
• Travel may be required.
• Perform all other duties as assigned.

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