Building Location:

Essentia Health Superior Belknap Pharmacy

Department:

48850 Prior Authorization

Job Description:

The Essentia Health Pharmacist-Medication Access Services will practice in an integrated, team-based care model providing clinical support of Medication Access Services team members in a remote setting. Primary responsibilities include but are not limited to benefits investigation and qualification of coverage, facilitating prior authorizations (PA), evaluating and supporting appeals requests, and conducting utilization management functions. The pharmacist will collaborate with nurses, providers, and other care team members with regard to coverage of patients’ medications to achieve excellent patient care and desired outcomes.

The pharmacist will support all aspects of daily activities including monitoring and assisting in directing programs to optimize drug utilization based on different third-party plan prior authorization criteria and prescribing patterns for designated drug therapies; supporting patient assistance program (PAP) team members with regard to clinical questions and patient counseling of medications dispensed to patients under PAP; supporting clinical criteria needed for accurate Medicare Part B billing for EH retail pharmacies; training of new staff and pharmacy students; resolution of patient issues; assisting in quality improvement initiative; and other duties assigned by the Medication Access Services Pharmacy Operations Senior Manager.

Education Qualifications:

Key Responsibilities:

• Clinical evaluation and benefits investigation on CAM orders placed by Essentia Health Providers
• Support Medication Access Associates with clinical questions when submitting prior authorization, verifying Medicare prescription eligibility, and applying for patient assistance
• Optimize drug utilization of designated drug therapies such as specialty-lite medications
• Navigate the electronic medical record to properly determine patient qualifications for a drug per third party requirements
• Effectively communicate and collaboration with providers, nursing staff, pharmacies, third parties, and software vendor to work through claims adjudication and processing issues coverage of patients’ medications to achieve excellent patient care and desired outcomes
• Provide direct patient interaction and counseling patients with their Manufacturer-based Patient Assistance Program medications

Educational Requirements:

• Successful completion of a residency program preferred
• Experience in managed care, formulary management, or medication therapy management preferred