Pharmacist Lead - Part D SME

(Formulary Administration and Coverage Determinations, Appeals and Grievances (CDAG) Pharmacist)

Work from Home

@Orchard LLC is supporting a not-for-profit corporation that partners with public and private sectors to create high-quality, safe, and efficient delivery of health care and human services programs. Our client has multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Our client is also a national leader in fighting fraud, waste, and abuse for large organizations across the country.  In addition, our client operates a foundation providing grant opportunities to those with programs for under-served communities.

The pharmacist shall be designated as key personnel and oversee the technical aspects of the project as they relate to all pharmacy matters, such as the formulary, drug interactions and pharmacy benefits management.

Experience Needed for this role: 

·         Extensive knowledge of how Part D prescription drug benefits are developed and managed.

·         A minimum of five (5) years’ experience in prescription drug benefit management with three (3) years’ experience managing a prescription drug formulary, medication therapy management, and drug interaction program.

·         Experience in the development of formularies and the review of claims to ensure clinically appropriate utilization. This shall include experience in claims analysis, claims data review for abnormalities, auditing of claims, developing prior authorization requirements for health care organizations, setting up edits and audits to ensure proper utilization of benefits, and setting up edits to safeguard against adverse drug interactions.

·         Knowledge and experience concerning the current uses of medications, new or emerging issues, issues related to electronic prescribing, among other general knowledge and experience in the prescription drug benefits.

Additional Preferred Experience: 

·         Knowledge of the purchasing and delivery of prescription drug benefits, preferably working as a high-level executive managing a prescription drug benefits program for a large employer, state Medicaid agency, large health plan or experience with Pharmacy Benefit Managers (PBMs).

·         Experience in the development, implementation, and purchasing of prescription drug benefits.

Education: 

·         A minimum of a bachelor’s degree in Pharmacy, and preferably a PharmD degree, from an Accreditation Council for Pharmacy Education (ACPE) accredited institution.

·         The pharmacist shall maintain a valid license to practice in at least one state within the United States.

If you match the requirements for this opportunity and believe you have the experience and talent to succeed in the role, we need to hear from you!

Established in 2010, @Orchard LLC, also known as, Talent Orchard has an exceptional reputation, providing staffing solutions to time-sensitive, talent scarcity issues to deliver better talent management ROI.  Our specialty lies in the critical area of program talent acquisition and resource management, not in one narrow skillset, but across many areas of technical and functional delivery. To learn more about our other exciting opportunities, visit our Jobs Page at www.atOrchard.com.