Clinical PA Pharmacist

**Description** **All the benefits and perks you need for you and your family:** Benefits from Day One Paid Days Off from Day One Career Development Whole Person Wellbeing Resources Mental Health Resources and Support **Our promise to you:** Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that **together** we are even better. **Schedule:** Full Time **Shift** : Monday – Friday **Location:** 582 Monroe Rd Suite 1412 Sanford, FL 32771 (This position will be remote after 90 days of successful onsite training and must remain local to Central Florida area) **The role you’ll contribute:** The Clinical Pharmacist working on the Prior Authorization (PA) team is responsible for reviewing prior authorization cases and rendering coverage determinations based on clinical criteria and AdventHealth employee prescription plan design. This position works to administer the criteria and conditions under which certain drugs, drug classes or categories require clinical review based on specific outlined guidelines. The PA team is responsible for the initiation, review, and ongoing follow up of all clinical utilization management programs and appeals processes, including specialty medications. The team triages all prescription claims that require review for the Clinical Trend Management Package, including but not limited to Pharmacy Benefits Manager (PBM) standard point of service Quantity Limit, Age Restriction, Step Therapy and Prior Authorization clinical edits through mail, specialty and retail networks. Consults various applications including pharmacy dispensing software, PBM database and EMR to gather complex clinical information, entering final benefit determination coding in the system(s). Works with corporate benefit team as needed on any second level appeals processes. **The value you’ll bring to the team:** Responsible for in-depth understanding of AdventHealth’s employee prescription plan; effectively articulates benefit determination details to providers and members in a way that is easily understood. Performs computer-based work and is responsible for review, interpretation, and response to data provided by providers regarding clinical utilization management edits for the AdventHealth employee prescription plan. Consults with providers’ offices regarding use of medications and appropriate formulary alternatives when requested. Research completely in pharmacy software, PBM database and EPIC EMR when reviewing PA criteria, ensuring coverage policies and criteria is administered consistently across specialty and non-specialty services lines. Works with providers’ offices to gather missing complex clinical information as needed, Demonstrates, through behavior, AdventHealth’s core values of Integrity, Compassion, Balance, Excellence, Stewardship, and Teamwork Collaborates with clinical and operational leaders to achieve stated goals and accountabilities including quality improvement and benefit design initiatives. Maintains company, member, and provider confidentiality as well as compliance with HITRUST and HIPAA regulations. Navigates across multiple computer systems, accurately documents all member communication appropriately and professionally within specific timeframes along with process updates at specified intervals or as needed. Works closely with diverse internal and external departments to manage daily operations within schedule, scope, and quality to meet established service level expectations. Determines daily goals and specific duty assignments for all tasks and monitors clinical edit workflow queues for appropriate and timely follow through. Partners with clinical and operational teams to uphold the strategic plan for the pharmacy that supports the organization's mission and goals; developing relationships within and across work groups to achieve results. **Qualifications** **The expertise and experiences you’ll need to succeed** **:** **EDUCATION AND EXPERIENCE REQUIRED** **:** Bachelor of Science degree in Pharmacy or Doctor of Pharmacy degree from an American Council of pharmacy Education accredited College of Pharmacy or foreign pharmacy graduate FPGEC certified by the NABP 2 years of experience as a pharmacist in a retail or outpatient pharmacy **_EDUCATION AND EXPERIENCE PREFERRED:_** Master of Health Administration, Master of Science in Pharmacy or Pharmacy Administration, Master of Business Administration, or other advanced degree in pharmacy or healthcare leadership Experience in specialty or retail pharmacy operations with multi-site responsibility Prior experience with operating a self-insured pharmacy benefit program Prior experience with operating a pharmacy specialty program **LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:** Current valid State of Florida Pharmacistlicense This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. **Category:** Pharmacy **Organization:** AdventHealth Corporate **Schedule:** Full-time **Shift:** 1 - Day **Req ID:** 23037205 We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.