Position Summary: We are seeking a highly skilled and experienced PBM Pharmacist to join our dynamic team. The ideal candidate will have a strong background in pharmacy benefit management, with a focus on optimizing prescription drug benefits and ensuring the delivery of effective medication therapy.
Key Responsibilities
Conduct coverage determinations and prior authorizations for prescription drugs, ensuring compliance with workers’ compensation criteria and guidelines.
Review and analyze workers’ compensation claims data for clinical appropriateness, cost efficiency, and therapeutic outcomes.
Provide evidence-based recommendations to prescribers, leveraging state-specific workers’ compensation guidelines to ensure optimal drug utilization.
Monitor drug utilization patterns, identify cost containment opportunities, and implement strategies to enhance drug therapy outcomes for patients.
Serve as a liaison between insurance companies, pharmacies, and patients to negotiate drug pricing and manage prescription benefits.
Develop and maintain formulary systems, perform drug utilization reviews, and manage fraud and abuse programs.
Support client plan benefit design discussions, customizing clinical and reporting requirements to meet individual population needs.
Requirements
Bachelor's degree in pharmacy or Pharm D and a valid pharmacist license.
Least two years experience as a pharmacist
Strong experience in PBM or related field, with a preference for candidates with account management experience in a PBM environment.
Seniority level
Mid-Senior level
Employment type
Contract
Job function
Human Resources
Industries
Hospitals and Health Care and Pharmaceutical Manufacturing
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