At HealthPartners, we believe in the power of good – good deeds and good people working together. We’re a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improves lives around the world. At HealthPartners, everyone is welcome, included, and valued. We’re working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.
Clinical Review Pharmacist
Location
United States
Posted
7 days ago
Salary
$73 - $85 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
Role Description
HealthPartners is hiring a Clinical Review Pharmacist. Service excellence is to be centered on patient care and patient relationships and is the responsibility of all employees. Teamwork is the norm and all employees will be held accountable to work as effective team members. The role involves:
- Reviewing, approving, and denying prior authorization requests in compliance with pharmacy policies, procedures, and standards.
- Providing support to physicians and pharmacy staff regarding prior authorization questions.
- Reviewing prior authorization requests for medical policy drugs and pharmacy benefit drugs; making coverage determinations for drug products according to member benefits and coverage criteria.
- Contributing to the development, maintenance, and communication of utilization management and exception criteria.
- Providing clinical guidance and support to the Pharmacy Customer Service Assistants and other Pharmacy staff when requested.
- Conducting research and analysis of coverage determinations and appeals on an ad hoc basis.
- Providing support and follow-up for escalated clinical issues.
- Researching drug information to maintain drug knowledge and disease state understanding for application to drug coverage reviews.
- Applying drug knowledge and evidence from literature to specific case situations, discussions with Medical Directors, and other peer review groups.
- Providing effective drug information and consultation to professional staff, providers, patients, and members.
- Ensuring strict adherence to the requirements of CMS, DHS, MDH, and other regulatory agencies.
- Supporting and cooperating with other departments’ operation initiatives.
- Maintaining a professional image.
- Adhering to the established Group Health, Inc., patient-service standards.
- Performing other duties as assigned.
Qualifications
- Must be a graduate from an accredited college of pharmacy and licensed as a pharmacist in the state of Minnesota.
- Must maintain this license in good standing as required by Minnesota law.
-
Must meet one of the following:
- Pharm.D.
- One year of recent experience in a managed care pharmacy setting.
- One year of recent clinical pharmacy experience that includes prior authorization experience.
- Demonstrated knowledge of pharmacodynamics, pharmacokinetics, pathophysiology, and therapeutic disease states commonly found in ambulatory patients.
- Demonstrated competency in all professional aspects of pharmacy.
- Strong leadership and organizational skills; maturity and dependability are essential.
- Ability to organize and function under stress with many interruptions.
- Ability to establish and maintain effective, friendly, and courteous working relationships with coworkers, physicians, and patients.
- Strong communication/listening skills and good telephone etiquette.
- Ability to accept and implement change.
- Ability to tactfully resolve complaints.
Requirements
- Experience working with pharmacy technicians (preferred).
- Experience working with Microsoft suite of products (preferred).
- Knowledgeable in CMS and DHS regulations as well as other compliance-related rules and entities (preferred).
Benefits
- Comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities.
- Commitment to nurturing diverse talents and valuing dedication.
- Support for work-life balance.
- Goal to help you thrive physically, mentally, emotionally, and financially.
Company Description
At HealthPartners, we believe in the power of good – good deeds and good people working together. We’re a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improves lives around the world.
At HealthPartners, everyone is welcome, included, and valued. We’re working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.
Job Requirements
- Must be a graduate from an accredited college of pharmacy and licensed as a pharmacist in the state of Minnesota.
- Must maintain this license in good standing as required by Minnesota law.
- Must meet one of the following: Pharm.D. One year of recent experience in a managed care pharmacy setting. One year of recent clinical pharmacy experience that includes prior authorization experience.
- Pharm.D.
- One year of recent experience in a managed care pharmacy setting.
- One year of recent clinical pharmacy experience that includes prior authorization experience.
- Demonstrated knowledge of pharmacodynamics, pharmacokinetics, pathophysiology, and therapeutic disease states commonly found in ambulatory patients.
- Demonstrated competency in all professional aspects of pharmacy.
- Strong leadership and organizational skills; maturity and dependability are essential.
- Ability to organize and function under stress with many interruptions.
- Ability to establish and maintain effective, friendly, and courteous working relationships with coworkers, physicians, and patients.
- Strong communication/listening skills and good telephone etiquette.
- Ability to accept and implement change.
- Ability to tactfully resolve complaints.
- Experience working with pharmacy technicians (preferred).
- Experience working with Microsoft suite of products (preferred).
- Knowledgeable in CMS and DHS regulations as well as other compliance-related rules and entities (preferred).
Benefits
- Comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities.
- Commitment to nurturing diverse talents and valuing dedication.
- Support for work-life balance.
- Goal to help you thrive physically, mentally, emotionally, and financially.
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