POSITION SUMMARY
The individual will have responsibility and oversight for the development, implementation and management of the Clinical Services for PharmPix’s Medicare lines of business, including but not limited to: CMS compliant formulary development and maintenance, clinical audit procedures and client support, coverage determinations, medication therapy management and drug management programs as well as reporting (both internal and client facing) required for the activities listed on here.
ESSENTIALS ROLES AND RESPONSIBILITIES
- Support the development of a proprietary Medicare adjudication platform for PharmPix.
- Support oversight of an external claims adjudication vendor.
- Develop, implement and maintain CMS compliant Standard formularies for PharmPix.
- Develop, implement and maintain CMS compliant custom formularies for PharmPix’s clients.
- Formularies may be needed for Medicare, Medicaid or Exchange lines of business.
- Develop and maintain Standard Operating Procedures that support formulary creation and maintenance.
- Develop, implement and maintain a CMS compliant Medication Therapy Management (MTM) Program
- Develop and maintain Standard Operating Procedures that support the MTM program.
- Develop, implement and maintain a CMS compliant Drug management Program (DMP)
- Develop and maintain Standard Operating Procedures that support the DMP program.
- Develop, implement and maintain a CMS compliant Coverage Determination process
- Develop and maintain Standard Operating Procedures that support Coverage determination management.
- Develop, implement and maintain a Clinical Audit program that supports client related CMS audits and client requested mock audits.
- Develop and maintain Standard Operating Procedures for the clinical audit team.
- Develop a program for internal mock audits to occur year-round.
- Oversight for internal and client facing reporting required for: Formulary management, Clinical Audits, MTM and DMP
- Recruit, train and supervise pharmacists, pharmacy technicians and clinical coordinators in the following areas: Formulary management, Clinical Audits, MTM and DMP.
- Any additional tasks required by PharmPix’s in support of client retention and growth.
TRAINING & EDUCATION
- Doctor of Pharmacy Degree
LICENSURE / CERTIFICATION
- Pharmacist License
PROFESSIONAL EXPERIENCE
- At least 5 years of government programs experience, preferably on Medicare.
PROFESSIONAL COMPETENCIES
Knowledge: Thorough knowledge of CMS policies and procedures.
Skills: Expertise in Microsoft Office suite of products.
Abilities:
- Task oriented.
- Ability to focus and meet tight deadlines for client requests.
- Teamwork.
- Ability to think outside the box to solve client opportunities.
- Effective communication skills.
PHYSICAL AND MENTAL DEMANDS
- The physical demands described here represent those that an employee must meet to perform the essential functions of this job successfully. While performing the duties of this job, the employee is regularly required to talk or hear, sit, stand, and walk.
- The position requires that the weight be lifted, and force is exerted up to 50 pounds.
- Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions.
ENVIRONMENTAL AND WORKING CONDITIONS
- This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines. Require evening or weekend work.
PharmPix is an Equal Employment Opportunity Employer Minorities / Females / Disable / Veterans