Lead Clinical Pharmacist Reviewer - Medi-Cal
Company: Magellan Health
Location: Rancho Cordova
Posted on: January 12, 2022
Facilitates the company's efforts in the development of medical
pharmacy solutions programs. Supports drug utilization review (DUR)
efforts by reviewing physician prescribing patterns, consulting
with physicians regarding these patterns using evidence-based best
practices, working closely with internal staff in the refinement of
the company's medical pharmacy management solutions programs,
providing consultation on pharmacy issues to clinical operations
representatives and facilitating the successful implementation of
these programs for customer organizations. Primary activities
center on discussions with practicing physicians (and other
prescribers) to consult on prescribing of specialty medications.
Coordinates with operations, clinical, medical, reporting and other
internal departments as needed.
- Pharmacy Data Review: Regularly reviews and monitors
prescription claims data and prescribing practices identified as
outliers by internal and/or external analysis of pharmacy claims
- Telephonic Consultations/Interventions: Contacts physicians and
prescribers identified as needing consultation to provide coaching
on prescribing practices that have been identified as outliers.
Reviews prior authorizations and determine opportunities for
- Intervention Tracking and Documentation: Tracks contact
attempts and contacts per operations procedures. Documents content
of and results of consultations as defined in operations
procedures; maintains records as required.
- Intervention Refinements: Collaborates on the refinement of
consultation scripting; solicits and utilizes input from those
contacted toward scripting improvements.
- Operations: Contributes to the success of the operations of the
pharmacy program by assisting with the implementation and
management of both written and verbal communications to physicians
and prescribers and maintenance of the edits and data elements that
support the edits. Is available for consultation on
pharmacy-related questions and issues for others within the
organization (e.g. health coaches, care managers, etc.). Updates
and maintains program engine, coding, consultation sheets and
outreach program as needed.
- Quality Improvement: Contributes to program improvements by
using continuous quality improvement processes, by being proactive
in identifying improvement opportunities and by contributing
on-going consultation and collaboration with product leaders.
- Medical/Clinical: Upholds clinical integrity of pharmaceutical
solutions by staying up-to-date on medication information,
contributing to the identification of pharmacy program best
practices, collaborating with Medical Directors, Medical Dept, and
Clinical Dept and provides pharmacy expertise within the
- Managerial Support : Supports system User Acceptance Testing
(UAT), performs monthly call audits to measure and report quality,
researches and resolves escalated issues, and maintains and
monitors clinical workloads to ensure performance goals are
- Coaching/Training: Provides support and coaching to Initial
Clinical Review (ICR) Pharmacists and other clinical team members
in the course of normal operations. Identifies team member training
needs and provides real time coaching/training. Act as a mentor to
other ICR Pharmacists and other clinical team members.
- Contributes creative solutions to improve operational
efficiency and effectiveness of pharmacy team.Other Job
RequirementsResponsibilitiesCalifornia Pharmacy License
7+ years' experience in clinical pharmacy with emphasis in
specialty pharmacy, oncology or other clinical pharmacy area.
Managed care pharmaceutical service experience plus experience with
coaching physicians and prescribers on medication issues,
especially on specialty medications.
Knowledge of current research related to specialty
medications.-Strong research and implementation skills in practical
Analytic skills which can translate into practical and pragmatic
Strong team orientation with respect for all members.
Strong verbal and written communications skills.
People skills are essential that allow for the successful
consultation with physicians, prescribers and pharmacists and for
successful collaboration with company employees and external
vendors who do not directly report to this job.
Must be comfortable with using computers and the internet; basic
skills with Microsoft office products and ability to quickly learn
For positions supporting Medicare Part B, 5+ years of PBM
experience required, 2+ years of Medicare Part B experience
required and 2+ years of audit experience required., Managed care,
pharmaceutical sales management experience.
Experience with pharmaceuticals in a pharmaceutical sales, retail,
or managed care environment, including contact with
Management experience in the coordination of and collaboration of
Managed pharmacy benefits organization experience preferred.General
Job InformationTitleLead Clinical Pharmacist Reviewer -
Medi-CalGrade30Work Experience - RequiredPharmacyWork Experience -
PreferredEducation - RequiredBachelors - PharmacyEducation -
PreferredPharmD - PharmacyLicense and Certifications - RequiredRPH
- Registered Pharmacist - PharmacyLicense and Certifications -
PreferredPharmD - Doctor Of Pharmacy, State Licensure -
PharmacyMagellan Health, Inc. is proud to be an Equal Opportunity
Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every
employee must understand, comply with and attest to the security
responsibilities and security controls unique to theirposition; and
comply with all applicable legal, regulatory, and contractual
requirements and internal policies and procedures. Associated
topics: dietetic, dietician, drug, drug discovery, food scientist,
histologist, physiology, therapeutic, toxicologist,
Keywords: Magellan Health, Rancho Cordova , Lead Clinical Pharmacist Reviewer - Medi-Cal, Other , Rancho Cordova, California
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