Performs prospective and/or retrospective drug utilization review. Coordinates the distribution of clinical drug information and educates providers and staff regarding the appropriate use of pharmaceutical treatment regimens within the Worker's Compensation Division.
- Improves quality of service to members by providing prior-authorization of formulary drugs, developing programs to provide optimal pharmacy care to patients, participating in dispute resolution of drug utilization review, measuring and documenting improvements in patient care, and/or improving claim adjudication for proper provider reimbursement.
- Collaborates with other medical personnel in developing treatment guidelines and demonstrates the impact of these guidelines. May participate in formulary development and management.
- Monitors prescribing habits of participating physicians. Makes recommendations to physicians to improve medication regimens as appropriate.
- Maintains the non-formulary exception program and/or the rebate program consistent with contract, state and/or federal guidelines.
- May audit providers to ensure accurate dispensing and billing of products. Collaborates with the pharmaceutical community to ensure timely payment is maintained.
- May support the drug rebate regulations and mandates by maintaining pharmaceutical reimbursement methodology for multisource products. Validates the clinical availability of multisource products for provider utilization.
- May assist the client with rebate reporting requirements.
- Supports the Pharmacy and Therapeutics Committee function.
- May develop and maintain a newsletter for provider staff, promoting rational prescribing habits.
- Performs other duties as required.
- Current unrestricted state (AZ) license required.
- Bachelor's degree from an accredited school of pharmacy or PharmD from an accredited school of pharmacy required.
- Board certification and residency preferred.
- Previous 2+ yrs of Clinical Pharmacy experience required. Workers Compensation, Managed Health Care experience is preferred.
- Strong pharmaceutical product and clinical pharmacy knowledge required.
- Knowledge of clinical program components, formulary designs, and prescription benefit trends.
- Excellent communication skills both written and verbal is required. Good business acumen is preferred.
- Proficient skill level with MS Office Suite ( Word, Excel, Outlook, Sharepoint and Powerpoint).
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Primary Location: Tucson, AZ, US
Organization: 43007 - First Script Network Services
Job Posting: 2013-03-13
Job ID: 1310937