Clinical Pharmacist
Current- Review medication coverage requests and assess the medical necessity against the plan’s formulary and policy criteria for pharmacy and medical drugs across multiple lines of business (i.e., commercial, exchange.
- Complete peer-to-peer interactions with providers to discuss member-specific situations and assess medical necessity based on current clinical guidelines and policies
- Precept pharmacy residents in analyzing coverage determination history to make recommendations on medication utilization management improvements to streamline the policies and reviews
- Update medication policies based on new indications and clinical guideline changes
- Review new medication approvals and provide evidence-based formulary recommendations and management strategies to the pharmacy and therapeutics (P&T) committee
- Provide prior authorization (PA) review training for new pharmacists and pharmacy residents on appropriate application of current guidelines, utilization management, and policies when making coverage determinations.
Nov 2021 - Present
