Medicaid Clinical Pharmacist

This is a fully remote position, open to applicants in United States.

📋 Description

• Engage in all facets of the Connecticut Medicaid program’s clinical services.

• Report directly to the Manager of the Connecticut Medical Assistance Pharmacy Program.

• Assess drug and drug class evaluations utilizing evidence-based research.

• Formulate clinical prior authorization criteria recommendations and documentation for the Connecticut client.

• Coordinate changes to the Preferred Drug List in alignment with Pharmacy and Therapeutics Committee recommendations.

• Offer clinical guidance, mentorship, and support to pharmacists handling account-based prior authorizations.

• Ensure consistent implementation of prior authorization criteria and address escalations.

• Assist the state client with fair hearings and escalations.

• Recognize opportunities for improvement and contribute to ongoing quality enhancement.

• Develop and uphold question sets and rules for Intelligent Prior Authorization during claims adjudication.

• Provide pharmaceutical expertise and uphold the clinical integrity of pharmaceutical solutions.

• Enhance operational efficiency and effectiveness of the account pharmacy team.

• Collaborate with development teams by providing business insights and guidance on product improvements and technical tools.

• Foster collaboration across the pharmacy and drug rebate sectors.

• Participate in corporate pharmacy team meetings.

⛳️ Requirements

• Minimum of five (5) years of experience in pharmacy benefit management.

• At least three (3) years of experience working with a Medicaid PBM account.

• Comprehensive knowledge of Medicaid regulations at both the state and federal levels.

• PharmD is required.

• Familiarity with HIPAA regulations and requirements.

• A licensed pharmacist is necessary; a Connecticut license is preferred but not mandatory.

• Experience in managed-care pharmaceutical services.

• Background in coaching physicians and prescribers on medication issues, particularly specialty medications.

• Ability to communicate clearly and accurately in both written and spoken English.

• Strong leadership skills and a proactive approach.

• Analytical abilities to convert information into actionable recommendations.

• Capability to work independently as well as collaboratively in a team setting.

• Ability to perform effectively and efficiently under strict deadlines.

• Excellent organizational, written, and verbal communication skills.

• Commitment to maintaining confidentiality and compliance with HIPAA.

• Proficient in PC operations and basic knowledge of MS Office.

• Skills in work organization and problem resolution.

• Proficiency with virtual communication platforms including Microsoft Teams, Skype, and Zoom.

🏝️ Benefits

• Flexible hours.

• Work-life balance.

• Opportunities for continuous learning and career development.

• 100% remote work option.

• Flexible vacation policy.

• 401(k) employer matching program.

• Comprehensive health benefits package.

• Educational assistance programs.

• Leadership and technical development academies.

• Up to 10% travel may be required.