Position Overview: MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. The Clinical Pharmacy Manager is responsible for identifying criteria and medications to continuously improve drug utilization management strategies for the pharmacy and medical benefit across all lines of business. The Clinical Pharmacy Manager is also responsible for administering and managing all clinical programs, including but not limited to individual case management, population management and medication therapy management. Scope of Role & Responsibilities: Completes annual review for all prior authorization criteria to ensure the most up to date clinical guidelines and therapies are incorporated for optimal, medically appropriate utilization management Creates prior authorization criteria for new medications as needed Performs quarterly and ad-hoc assessment of formularies, using internal and external trends to ensue formulary appropriateness Administers and manages all pharmacy case management programs, including the Behavioral Health Pharmacy Program Provides education to staff on new therapies, new criteria, new guidelines to ensure internal pharmacy staff are well versed on up-to-date trends Assist in responding to internal/external inquiries related to prior authorization reviews Assists in identifying inappropriate utilization during quality check reviews for claims and prior authorizations by internal or Pharmacy Benefit Manager (PBM) delegated reviews Assists in identifying potential Fraud, Waste and Abuse scenarios Completes medication reviews for Plan members to ensure safe and effective therapy Assists in organizational and departmental quality improvement initiatives Manages internal Pharmacy and Therapeutics (P&T) meetings Required Education, Training & Professional Experience: Doctor of Pharmacy required. Minimum 4 (four) years’ clinical pharmacy experience and utilization management experience in a managed care environment required Experience in pharmacy management of government programs (Medicaid, Medicare, Exchange) preferred Residency PGY-1 training preferred. Proficiency with MS Word, Excel, and PowerPoint is required Proficiency with MS Access is preferred Position requires excellent organizational, teamwork, interpersonal, time management, written and verbal communication skills Licensure and/or Certification Required: Current New York State Pharmacist license (active and not limited) Professional Competencies: Integrity and Trust Customer Focus Functional/Technical Skills Written/Oral Communications #LI-Hybrid #mph50
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