The purpose of this position is to bring the experience, knowledge, and status of a clinical pharmacist to the pharmacy services department. The pharmacist will support and maintain our workers compensation and auto injury formularies, ensure state guideline compliance, and provide clinical support for our medication prior authorization process. In addition, the pharmacist will represent CorVel as a product expert and assist the sales and support staff with new client acquisition and existing client support.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
- Responsible for building and managing prior authorization forms and workflows.
- Process, review and analyze pharmacy usage data to determine best injury related formularies and Prior Authorization (PA) workflows.
- Respond to escalated inquiries and correspondence regarding coverage determination including client, legal, and compliance requests and initiatives, as well as daily requests for PA modifications.
- Handle escalated flagged claims regarding medication usage by claim, using clinical modelling data of Morphine Equivalency and Pharmacy Risk scores to ensure the needs of CorVels clients and their claimants are met.
- Participate in Medication Reviews with prescribers to help manage at risk claimants.
- Ensure short-term use adherence for pain medications. Work with treating prescribers, nurse case managers, and adjusters to explore and recommend alternative pain solutions on a case-by-case basis, flagging those cases signaling possible dependency issues.
- Keeping up-to-date with new medications/therapies and upcoming brand to generic changes. Provide an overall plan and assist in the conversion of brand and combination drugs to their generic, singular components.
- Representing the organization to customers, the public, government, and other external sources. This information can be exchanged in person, in writing, by telephone, or e-mail.
- Researches and maintains state medication treatment guidelines and formularies to ensure compliance. Represent the interests of CorVel clients ensuing compliance with state regulations.
- Represents the Pharmacy team with clients when presenting formulary updates and changes. Review clinical and usage patterns to determine appropriate formulary needs for CorVels clients.
- Review utilization and medication review reports to confirm proper compliance.
KNOWLEDGE & SKILLS:
- Effective multi-tasking skills in a high-volume, fast-paced, team-oriented environment.
- Ability to interface with all levels of staff, physicians and their representatives, and advisors/clients and coworkers.
- Excellent written and verbal communication skills.
- Ability to meet designated deadlines.
- Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets.
- Strong interpersonal, time management, and organizational skills.
- Ability to work both independently and within a team environment
- Experience with Pharmacy Claims Management systems preferred.
- Doctor of Pharmacy (PharmD) degree preferred.
- Current PharmD license preferred
- Workers Compensation Experience preferred.
- Valid drivers license and good driving record with no traffic violations
- Strong cost containment background, such as utilization review or managed care preferred.
In order to provide equal employment and advancement opportunities to all individuals, employment decisions at CorVel will be based on merit, qualifications and abilities. Except where required or permitted by law, employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex, national origin, ancestry, citizenship, age, handicap or disability, marital status, medical condition or any other characteristic protected by applicable law. Please be aware that CorVel generally does not review all applications submitted in response to job openings posted on the Internet because of the large volume of responses. Note to Employment Agencies: Please do not forward agency resumes. CorVel Corporation is not responsible for any fees related to unsolicited resumes.