• Job Description

  Req#: 25-67246
  
  Exception Template-Clinical Formulary Pharmacist - 580221
  
  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 • Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews • Provide clinical guidance and support to the assigned pharmacy technicians • Provide support documentation and develop communication for the Pharmacy &Therapeutic (P&T) Committee review process and decisions
  
  Education/Experience: Bachelor’s degree or advanced degree (PharmD., M.S) in pharmacy. 3+ years of combined managed care pharmacy or pharmacy residency program experience.
  
  Licenses/Certifications: Current state’s Pharmacist license with no restrictions.
  
  EEO:
  
  “Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”
  
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  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 • Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews • Provide clinical guidance and support to the assigned pharmacy technicians • Provide support documentation and develop communication for the Pharmacy &Therapeutic (P&T) Committee review process and decisions Education/Experience: Bachelor’s degree or advanced degree (PharmD., M.S) in pharmacy. 3+ years of combined managed care pharmacy or pharmacy residency program experience. Licenses/Certifications: Current state’s Pharmacist license with no restrictions.
  Story Behind the Need
  What is the purpose of this team? Describe the surrounding team (team culture, work environment, etc.) & key projects. Do you have any additional upcoming hiring needs or is this request part of a larger hiring initiative?	Purpose of the team is to create decision tools (questionnaires) that follow P&T guideline criteria for prior authorization and support the PA team to make coverage determinations on PA requests. Work is project-based, requires strong written and oral communication skills, and requires intermediate technical proficiency. Team is extremely results-oriented and purpose-driven.
  Typical Day in the Role
  Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD). What are the performance expectations/metrics? What makes this role unique?	Oversee and review technician work for quality control on decision tool configurations using Microsoft Excel, Visio, and the PA system (MHK/Compass) Create and primary review decision tool diagrams on Microsoft Visio against clinical resources and yes/no question logic Perform root cause analysis on functional testing to ensure decision tools are working as intended Follow training instructions and complete training sessions in a timely manner. Expectation will be to maintain high-quality level work. Pay close attention to details. Complete assignments on time (deadlines range from weekly to monthly). Requires clinical pharmacy skills as well as a good understanding of PBM pharmacy operations.
  Candidate Requirements
  Education/Certification	Required: Doctor of Pharmacy (PharmD)	Preferred:
  Licensure	Required: Current state’s Pharmacist license	Preferred:
  Years of experience required: a) 3+ years pharmacy experience or b) 1-year PGY1 residency or c) managed care experience Disqualifiers: Additional qualities to look for: Experience with projects or assignments that require high attention to detail, Ability to properly prioritize and reprioritize work, Able to adapt and be flexible with changes in processes.
  Top 3 must-have hard skills stack-ranked by importance	1	Strong clinical understanding of therapeutic guidelines
  2	Microsoft Office Experience – Excel, Word, Outlook, Visio
  3	Ability to work independently and keep good communication about their project/assignment updates.
  Candidate Review & Selection
  Shortlisting process Candidate review & selection Interview information Onboard process and expectations	Projected Manager Candidate Review Date:	1-2 days post shortlisting
  Type of Interviews:	Teams-camera on
  Required Testing or Assessment (by Vendor):	NA
  Next Steps
  Additional background check requirements (List DFPS or other specialty checks here)	None
  Do you have any upcoming PTO?	9/1 to 9/5
  Colleagues to cc/delegate	To be determined
  Are there any training requirements (time off, alternate schedule, etc.)?	Must complete training within first 3 months.
  
  

• About the company

  Mindlance is one of the largest diversity-owned staffing firms in the US . As a recruitment centric talent acquisition company, Mindlance provides Technology, Engineering, Digital / Creative / Marketing, Clinical Research, Scientific, Finance, Professional and Payroll Management staffing services to Global 1000 companies across the US, Canada and India.

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