Navitus Health Solutions
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Clinical Staff Pharmacist
at Navitus Health Solutions
LocationMadison Campus: Madison, Wisconsin
Essential Background Requirements:
A minimum of a Pharm. D. degree and current unrestricted licensure as an RPh in the State of Wisconsin is required.
Minimum of two years clinical experience, or clinical or managed care pharmacy practice residency and one year of clinical experience. Knowledge of the PBM industry, formulary management, pharmacy claims and managed care principles and practices is desired. Knowledge of specialty pharmacy drugs, how to deliver patient centered care, and clinical program development are required. Exceptional clinical skills and the ability to apply sound clinical judgment to a variety of situations. Advanced training in specialty area is desired. Proficiency in drug literature and clinical trial evaluation, including proficiency with electronic databases (e.g., Micromedex, Medline, Internet) preferred. Ability to reason and translate clinical information into a manner appropriate for clinical and non-clinical audiences. Emphasis is placed on problem-solving skills, including identifying and accepting a challenging situation and creating and implementing a solution. Requires attention to details in order to assure projects are clinically, editorially, and systems accurate and can be operationalized. It is very important for this position to be able to translate clinical information into process logic. Proficiency in MS Word, Excel, Access and Power Point including use of tables, charts and figures preferred.
The Clinical Staff Pharmacist is responsible for providing the pharmacotherapy expertise for the pharmacy program by assisting with the Pharmacy and Therapeutics (P&T) Committee and drug information process as well as performing Prior Authorization reviews. This position will be responsible for providing new drug reviews and drug class reviews for the Navitus P&T Committee. This person will be responsible for presenting at Navitus and external P&T committees. The person in this position will be responsible for analyzing available data to maintain a predictive drug pipeline database, which will include projection of utilization and cost trends. The primary functions involve ensuring that Navitus is able to provide clinically sound medications in the most cost-effective manner.
· Work with the clinical pharmacists to perform the daily, weekly and monthly/periodic reviews and monographs of drugs and therapeutic categories
· Provide recommendations for utilization management restrictions including prior authorization, step therapy, and concurrent DUR criteria
· Present at Navitus and external P&T committees
· Participate in the Coverage Determination (Certification, Prior Authorization, Medical Exception, Exception to Coverage, etc.) process be reviewing all requests which are not clearly approvable based on specified criteria (algorithms), making all coverage denial determinations, and identifying themselves by first name, title, and responsibility at Navitus in relation to drug utilization management program administration
· Responsible for assisting CAE pharmacists in the creation of communication and educational information to clients and members including drug pipeline surveillance and drug information
· Complete all annual URAC training requirements
· Maintain open lines of communication with other functional areas/departments
· Assist Customer Service, Account Managers and other internal customers in responding to and resolving pharmacy-related inquiries from members, clients, providers or pharmacies
· Provide effective communication of the companies vision, mission, values, goals and policies
· Participate in meetings and committees regarding goals, vision and strategic plans
· Responsible for staying current with clinical literature and guidelines, and relaying those to Navitus core teams and program managers
· Other duties as assigned