Location US-IL-Champaign

ID 2024-8257

Category

Allied Health

Position Type

Full-Time

Remote

No

Shift

Day

Schedule

M-F, 8a-5p

Weekend Requirements

as needed

Holiday Requirements

No

On-Call Requirements

No

The Clinical Pharmacist is responsible for support of the formulary process, utilization management criteria development and application, drug utilization review, Fraud Waste and Abuse, and member and provider education. The Clinical Pharmacist analyzes clinical data from multiple sources to assist in developing pharmacotherapy recommendations that encompass population health, quality management, and care management. The Clinical Pharmacist provides direct patient care related to medication prescribing, administration, and monitoring within a care team model and provides clinical expertise to assist the care team in completion of their duties. This individual also participates in focused medication studies as applicable.

Performs utilization management reviews.
Serves as drug information resource for other departments.
Assists with creation and maintenance of administrative and utilization management policies.
Assists Compliance Department with identifying and investigating potential fraudulent or inappropriate practices.
Maintains current knowledge of and ensures compliance with government and commercial regulations.
Additional functions as needed including but not limited to PBM reporting, review of fraud waste and abuse reports, and project based work.
Conduct medication reviews at the request of member, provider, or Care Coordinator.
Serve as a subject matter expert for various committee or subcommittees requiring pharmacy knowledge.
Perform provider and member outreach calls as needed to close identified gaps in care.

License/Certifications:
Ambulatory Care Nursing Certification (AMB-BC) - American Nurses Credentialing Center (ANCC); Licensed Pharmacist - Illinois Department of Financial and Professional Regulation (IDFPR)

Education:
Doctorate: Pharmacy; Experience In Lieu of Education

Other Knowledge/Skills:

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