Rema Farran, Pharm D Email & Phone Number

Windsor, Ontario, Canada

• Serve as a SME in delivering pharmacy benefit management services for WithMe’s clients• Work with Director of Clinical Impact and a team of pharmacists to provide the best medication guidance experience for our members• Manage and partner with WithMe’s support vendors to maintain current and custom clinical programs and services, including formulary and utilization management programs• Ensure products, programs and services provided are consistent with best practice approaches and in compliance with State/Federal requirements, as applicable• Aid in the development and management of RFP process focusing on cost containment and utilization management strategies for potential clients• Provide pharmacy insight and knowledge of key industry trends, product pipelines, specialty medications at both pharmacy and medical benefit channels, formulary and utilization management and rebate strategies, and other pharmacy product and services innovations to WithMe clients.• Partner with WithMe’s Finance, Underwriting and Analytics staff to review, interpret, and provide commentary, recommendations, and forecast medication costs for WithMe clients.• Provide level of services that is appropriate for client-specific time zones and hours of operation.• Ad hoc analyses and projects as requested by WithMe or WithMe Clients.

Kansas, United States (Canada - Remote)

- Develop and maintain custom and standard formularies based on State mandated and company and/or client requirements in formulary tool and claims processing systems - Provide clinically sound recommendations regarding formulary changes in all lines of business as it relates to utilization management such as prior authorization, step therapy, quantity limitation, age restriction, or tier placement - Oversee daily clinical formulary operations, ensure plan compliance and provide clinical and operational support across cross-functional teams including, but not limited to, rebates, benefits, claims, and specialty - Partake in contract management as it pertains to customer and client relations- Management of the creation, revision, and improvement of policies, procedures, data and new programs pertaining to Medicaid, Medicare Part D, Commercial, Marketplace, and custom formulary maintenance - Participate in program creation and management as it relates to claims testing and validation - Conduct quarterly clinical full formulary reviews to provide clinical recommendations for formulary changes - Participate in external client meetings and management in collaboration with account management- Creation, management, and delivery of quarterly pipeline reports to internal and external stakeholders - Participate and lead in project management as it relates to formulary customer relations, inquiries, or product enhancement or improvement- Participate in vendor management as it relates to formulary and rebate strategies- Review and creation, recommendation, and management of specialty medication drug lists

Detroit, Michigan, United States

Position Purpose: Define and develop standard and custom formularies for all lines of business including Commercial, Medicaid, Medicare Part D and the Health Information Marketplace- Develop drug product review and formulary recommendations by assessing drug use trends, new drug releases and review of primary literature- Analyze pharmacy cost of care, trends, and coordinate the development of appropriate use protocols and guidelines -Set criteria for medication analysis, coordinate reports to clients, meet regulatory reporting requirements for drug utilization review and fraud and abuse reporting- Develop clinical criteria for review of non-formulary or non-preferred drug lists medications and communicate recommendations to clients- Develop and design clinical edits to adjudicate claims and enhance drug utilization- Develop and review guideline criteria for prior authorization and non-formulary drugs in support of - Pharmacy and Therapeutics Committee function and pharmacy benefit design- Provide support documentation and develop communication for the Pharmacy &Therapeutic (P&T) Committee review process and decisions

Detroit

- Conducts drug utilization evaluations in order to foster best practices in prescribing, dispensing, administration, and monitoring of outcomes.- Performs detailed claim analysis for over and under drug utilization.- Provides clinical pharmacy direction for the health plan by reviewing therapeutic medication classes for the P&T committee.- Performs medication class reviews and recommends the status of new medications placement on the Medicaid PDLs- Assists with the development/maintenance the Medicare/Medicaid PDLs and ensures systematic programming of formulary medications are accurate.- Contributes to the development of Medicare/Medicaid prior authorization criteria and protocols.- Communicates with teams to ensure the formulary alternatives are updated and published on the corporate websites- Effectively collaborates within Pharmacy and across the enterprise to ensure that the Medicare formulary is designed to meet the needs of the general Medicare population.- Develops clinical education pieces for members/providers regarding formulary changes for the Medicare/Medicaid lines of business. Disseminates education and formulary related information.- Provides clinical instruction to pharmacy students/residents as assigned- Supports the efforts of the pharmacy call center via proactive communication of any impactful drug coverage changes.- Proactively reviews pharmacy data with a goal of identifying cost savings opportunities.- Assists in the development, review and execution of department standard operating procedures, step action plans/workflows, training materials and other documents as required.- Partners with individual state pharmacy directors to ensure that state requirements are met.- Participates on assigned corporate committees, including Pharmacy and Therapeutics and Drug Utilization Review committees.

Detroit

- Provide clinical and pharmacoeconomic support and recommendations to the Manager of Clinical Operations relating to formulary, criteria, and P&Ps that ensure safe, efficacious, and cost-effective prescribing and drug use- Maintain drug pipeline for pharmacy benefits and medication related medical benefits (JCodes)- Collaborate closely with other departments to review and analyze utilization data to provide recommendations supporting the use of efficacious, cost-effective therapy- Work in conjunction with Clinical Programs team to support development and alignment of clinical programs for medical and pharmacy benefits with utilization management trends and analysis- Provide clinical support for client and State requested reports, drug monograph review, clinical criteria development, formulary enhancement review, drug utilization review, etc. as needed.- Maintain, facilitate access to, and distribute clinical formulary information, recommendations for formulary drug positioning, and revision of UM in collaboration with the Clinical Operations Leadership, Chief Medical Officer, and other key stakeholders- Track, monitor, and analyze utilization reports to regularly assess implementation of clinical and policy decisions- Coordinate information from drug manufacturers related to P&T review, quality improvement review, UM review, including manufacturer incentives and rebate programs- Respond to day-to-day business issues with subject matter expertise- Maintain awareness of trends, developments and governmental regulations in managed healthcare organizations and government programs- Review and analyze prior authorization trends and utilization trends to provide comprehensive review and recommendation of drug approval criteria updates, formulary guideline updates, and P&P updates.- Partner with the internal departments to provide clinical support for medication and therapeutic class related projects, creation of drug specific resources as needed.

Detroit

- Provide clinical support for client and State requested reports, drug monograph creation and review, clinical criteria development, formulary enhancement review, and drug utilization review- Participate in formulary development and management- Create formulary criteria, drug approval criteria, and manage policy & procedure (P&P) updates and requests related to management of drug utilization- Partner with the internal departments to provide clinical support for medication and therapeutic class related projects and creation of drug specific resources- Review escalated appeals and grievances and represent MeridianRx in state fair hearings- Collaborate with Chief Medical Officer for External Review requests- Respond to provider and member questions regarding the pharmacy benefits program- Assist with drug recall and alert communication, medication backorder alerts and safety programs- Assist with the preparation and distribution of communication materials between the plan and participating providers- Provide clinical support and recommendation regarding claims review for potential Fraud, Waste, and Abuse (FWA) Case Management- Assist the pharmacy care coordinators with drug information and review of complex cases- Review prior authorizations, reconsiderations, and appeals for multiple lines of business including Medicaid, Medicare and commercial

Detroit, Mi

- Improve quality of service to members through prior authorizations, program development, drug utilization review, and patient care - Collaborate with other medical team members to develop guidelines- Review of authorization, denial, and appeal utilization- monitor prescribing patterns and make recommendations- Assist in drug recalls, alerts, and pharmacy care coordination in drug information and review- Assist in preparation of state-required reports through the pharmacy and therapeutics committee- Perform MTM for members

Southfield, Michigan

- Prescription order entry, verification, and filling- Over-the-counter medication recommendation and consultation- Management of overall workflow and technician processes- Medication therapy management- Excellent Patient care and consultation- Prescription and documentation filing- Maintain proper compliance and execution of federal and state rules, laws, and regulations- Verification and consultation of prescriptions with physicians and other such professionals- Clarifications of insurance coverage and policies- Immunization delivery services and consultations- Patient medication therapy side effect and outcomes consultations - Inventory quality control, management, and ordering

Detroit, Michigan

- Prescription order entry and filling- Over-the-counter medication recommendation and consultation- Prescription and documentation filing- Verification and consultation of prescriptions with physicians and other such professionals- Clarifications of insurance coverage and policies