Managed Care Pharmacist

Overview:

Pharmacy jobs within a managed care environment can be very attractive for pharmacists due to the flexible schedules that are offered, the closed-door environment and the ability to work from home. As a pharmacist, you have the chance to work in several areas of pharmacy from specialty pharmacy to working on plan design and even a more traditional role of prescription fulfillment. As PBM's play a bigger role in the industry's future, there will be expanding opportunities for pharmacists to help shape the way pharmacy is practiced.

 

Examples of jobs in managed care include:

 

Clinical Pharmacist - Utilization Management:

Provides support for the prior authorization department and for utilization management activities. These pharmacists are responsible for approving prior auth denials or override requests. They must consider the clients' benefit design plan and assess the clinical criteria and are in direct communication with physicians and other healthcare professionals. They also contribute to educating other departments by continuous involvement in committees and training. This position is considered a central point of contact and an expert across all lines of business.

 

Mail Order Pharmacist:

Mail order is considered a production environment where there is a high volume of prescriptions so responsibilities my be divided for optimal production and output and there are usually goals or quotas that need to be met. Responsible for verifying prescriptions as entered by data entry, analyze drug therapies and monitor profiles to avoid interactions and inappropriate dosage. Responsible for compounding, dispensing and inspecting medications. Work with automated equipment to ensure medication accuracy. Responsible for fielding calls from patients regarding use of their medications. Responsible for incoming doctor calls regarding misfills, lost orders, new prescriptions, fax verifications, etc. Make outgoing calls to physicians or patients to verify or make changes to medications. Initiate therapeutic switches of medications to comply with clients' formularies and/or generic requirements.