Job Details

New Pharmacist position with one of our most reputable healthcare organizations in Durham, NC.

Job Profile Summary

Engage Medicare members, pharmacies, and providers to close adherence and SUPD (Statin Use in Persons with Diabetes) gaps. Complete Comprehensive Medication Reviews (CMRs) with Medicare members.

Make outreach to Medicare members to assist in removing barriers to medication adherence.

Partner with pharmacies and providers to close adherence gaps when the Medicare member is unengaged or when the Medicare member requires assistance.

Contact providers to close SUPD (Statin Use in Persons with Diabetes) gaps.

Complete Comprehensive Medication Reviews (CMRs) with eligible Medicare members to give the member a better understanding of their medications and health.

Send interventions to providers through fax or the CMR platform to alert the provider of potential drug interactions and adverse reactions, dose changes, adherence issues, etc.

Provide counseling to Medicare members regarding medications.

Provide Medicare members with information regarding their pharmacy benefits (ie. formulary, preferred pharmacy, supplemental benefits, etc.)

Provide clinical guidance and support to the Pharmacy Quality Specialists

- Review prior authorization requests and make determinations for drug products according to member benefits and coverage

criteria

- Report to utilization review statistics to corporate compliance committees

- Review data and summarize daily utilization review numbers

- Responsible for tracking compliance of review cases

- Provide clinical guidance and support to the assigned pharmacy technicians

- Knowledge of drug coding (NDC, GCN, GPI and USC) and NCPDP claims adjudication systems

- Review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design.

- Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices

- Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization

reviews

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact ...@randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.