Develop clinical criteria for medications and recommend plan design changes and clinical programs to be initiated. Develop and implement programs designed to impact DUR for both Medicaid and Medicare.
Numbers & Facts
Location
Various, FL (Remote)
Salary
$94.34 Per Hour
Description
Summary:
Work Mode: 100% Remote any time zone EXCEPT PST
Duration: 3 months contract
SHIFT: 9 AM – 6 PM local time (EXCEPT PST), no OT requirements
Responsibilities:
Review a patient’s medical information and pharmacy claims for gaps in care, drug therapy problems, etc. with an expectation of 90% productivity daily
Develop clinical criteria for medications and recommend plan design changes and clinical programs to be initiated
Monitor prior authorization requests
Provide clinical support to internal departments and address clinical-related questions
Ensure appropriate quality controls and initiate opportunities for performance improvement in pharmacy/practice
Develop and implement programs designed to impact DUR for both Medicaid and Medicare
Develop, implement, and maintain policies and procedures for the pharmacy department
Participate in the coordination of the Medicare MTM program
Assist case management team with members, including clinical rounds presentations