JOB SUMMARY

We are seeking a dedicated and detail-oriented clinical pharmacist for an operation-centric role focused on conducting clinical reviews of medical data to facilitate prior authorization for specialty medications. Provides clinical pharmacy services and support to assist the Prior Authorization, Case Management and Quality teams.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Prior Authorization review and approve or deny coverage for pharmaceuticals based on medical necessity criteria. Coordinates with medical directors as needed

• Specialty Drug claims review based on medical necessity criteria
• Comprehensive Medication Management Review for complex members in Case Management
• Assists withTransitions of Care Medication Reconciliation Post-Discharge (TOC MRP)
• Supports Quality with Medication Adherence Measures
• Redirects pharmaceuticals to PBM when appropriate

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

• Ability to communicate effectively both verbally and in writing.
• Experienced computer skills with Microsoft Word, Microsoft Outlook, Excel and experience working in a health plan medical management documentation system.

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• Requires BA/BS in Pharmacy; PharmD preferred
• Experience reviewing Medical Drugs (J-codes and Q-codes a plus
• Three (3) to Five (5) years of pharmacy experience.
• Two years of managed care experience in Medical Management preferred.
• ICD-9 and CPT coding experience preferred.
• Experience in EZ-CAP preferred.
• Prefer Prior Authorization experience

REQUIRED CERTIFICATIONS/LICENSURE

Include minimum certification required to perform the job.

• Requires a registered pharmacist
• Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh)
• Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills a must

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to work in sitting position, use computer and answer telephone
• Ability to travel
• Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Office Work Environment

OTHER

• some travel may be required

Compensation and Benefit Information

Compensation
• Pay: $44.52-$66.78 per hour. Compensation depends on location, qualifications, and experience.
• Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
• Conifer observed holidays receive time and a half.

Benefits
Conifer offers the following benefits, subject to employment status:
• Medical, dental, vision, disability, and life insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.