* Assists with planning, and leads medical and claim payment policy activities while ensuring conformance to departmental policies and procedures. Convenes multidisciplinary meetings, workgroups or expert panels to resolve complex issues as required. o Review of medical and claim payment policies o Utilization Management (UM) Committee creation and maintenance for CMS requirement. * Orients new staff, serves as a mentor, and provides oversight of assignments and projects of… Show more * Assists with planning, and leads medical and claim payment policy activities while ensuring conformance to departmental policies and procedures. Convenes multidisciplinary meetings, workgroups or expert panels to resolve complex issues as required. o Review of medical and claim payment policies o Utilization Management (UM) Committee creation and maintenance for CMS requirement. * Orients new staff, serves as a mentor, and provides oversight of assignments and projects of other policy staff, and routinely updates management as appropriate* Provides management with required tracking data and productivity reports. * Recommends and implements departmental process efficiencies.* Serves as a liaison to other departments of the Company and represents the department at meetings and on work groups. Interacts with outside contractors, consultants, and other organizations.* Additional tasks from the Senior Clinical Pharmacist position Show less

* Systematically evaluates and interprets results of published research and other clinical data in order to evaluate safety and effectiveness of injectable and infusible drugs, biologicals, and other services. Responsible for policy coverage development activities.* Evaluates and analyzes utilization patterns and makes recommendations to achieve the most cost-effective utilization for services covered through the medical benefit.* Interacts with Injectable Strategy Team regarding drug… Show more * Systematically evaluates and interprets results of published research and other clinical data in order to evaluate safety and effectiveness of injectable and infusible drugs, biologicals, and other services. Responsible for policy coverage development activities.* Evaluates and analyzes utilization patterns and makes recommendations to achieve the most cost-effective utilization for services covered through the medical benefit.* Interacts with Injectable Strategy Team regarding drug utilization metrics and design/implement programs as needed to achieve cost savings. Presents reports and presentations as required. Show less

* Evaluated, summarized, and interpreted results of published research and other clinical data on high-cost injectable and infusible drugs, biologics, pharmacogenomics tests, and other services under the Medical Benefit in order to evaluate safety and efficacy. * Developed criteria for all Medical Drug Policies and determine coverage positions of the services provided under the Medical Benefit.

* Write and review clinical content for drug handbooks and journals, including Nursing Drug Handbook , Nursing Magazine, Springhouse Nurse’s Drug Guide, Nursing Made Incredibly Easy!, and The Nurse Practitioner.

* Responsible for the accuracy of drug information for all drug publications (e.g., drug handbooks, flash cards, websites) for health care practitioners, including the top-selling Springhouse Nursing Drug Handbook.* Created and updated drug monographs with new FDA-approved indications and off-label indications.

* Collaborated with hospice providers to provide comfort to each patient by constructing an appropriate, cost-effective, palliative medication plan.

* Communicated drug information to health care providers and patients.* Processed and prepared prescriptions in a timely fashion.