Clinical Pharmacist
Current- Evaluates complex clinical information and insurance policies to make coverage determination for prior authorizations and appeals for commercial and Medicare plans in a managed care environment.
- Integrates evidence-based medicine and pharmaceutical knowledge to ensure the clinical appropriateness of treatments and adherence to guidelines.
- Consults with other healthcare providers regarding use of medications and suggesting appropriate formulary alternatives as needed.
- Ensures compliance with state and federal regulations in clinical reviews and provider and member communications.
- Resolves insurance claim issues to prevent delays in patient care and help reduce medication costs to ensure patient access to care.