Precert Clinical Pharmacist

Precert Clinical Pharmacist

 

JOB RESPONSIBILITIES:
Provide ongoing clinical pharmacist support in a fast paced pharmacy precertification unit in a national managed care pharmacy department with two locations handling precertification requests for our HMO, PPO, and Medicare members. Responsibilities include but are not limited to: Respond to criteria and clinical questions from technicians and other internal employees. Review/handle written and verbal requests from physicians, members, and long-term pharmacies. Assist as appropriate with clinical aspects of grievances and appeals. Review and approve precertification denials on daily basis. Provide feedback to technicians on a daily basis. Handle call backs to physicians and members regarding questions around denials and criteria clarification. Handle supervisor calls regarding clinical precertification unit issues. Assist with coordination of documentation and requested files for NCQA reviews. Conduct training of the criteria and Formulary for the pharmacy technicians. Work cross-functionally with other groups of clinical pharmacists at Aetna including pharmacists in the Formulary Development unit, Medicare unit, Clinical Pharmacy Programs unit, and Regional Clinical Account Pharmacy Directors. Understanding the Medicare Part-Drug benefit to assist with processing precertification requests.

SKILL OR EXPERIENCE REQUIREMENTS:
Pharmacist degree with active pharmacist license required. Experience in managed care, Formulary development or Formulary management preferred. Experience in customer service settings helpful. Experience in geriatric pharmacy helpful.

The candidate should have experience in Formulary Management and pharmacy coverage benefits. Experience in reviewing and interpreting medical information. Has excellent drug knowledge and ability to know where to find clinical answers. Possesses excellent customer service skills, and enjoys working and interacting with others, including members and medical professionals. Enjoys a fast paced environment, and can work with a sense of urgency in handling issues. Must be able to organize and manage multiple tasks. Must be self-motivated and interested in learning new skills. Ability to ask appropriate questions to obtain relevant information and also verbally present information in an organized, clear and articulate manner. Strong verbal and written communication skills. Should have the ability to work independently and be pro-active in handling clinical and coverage situation/issues. The candidate should have leadership ability, and demonstrate high productivity. Proficiency in Microsoft Excel and Word. Ability to learn and train on new technologies.

ADDITIONAL JOB INFORMATION:

This position can be located in either Minnetonka, MN or San Antonio, TX.  The Formulary Development and Pharmacy Clinical Policies unit is responsible for supplying clinical pharmacy support to all of Aetna Pharmacy Management coverage, benefits and programs that serve our Commercial and Medicare members, providers, & plan sponsors. Responsibilities of the unit include clinical development/support of Aetna's National Formularies, our Pharmacy Clinical Policy Bulletins, clinical staff support for the Pharmacy Precertification Units, and providing drug information and evaluation. This position will support a National Pharmacy Precertification Unit. The clinical pharmacists are on a team with other pharmacists as well as pharmacy technicians and support staff in two locations. Coordination with medical management is our goal.

 

HOW TO APPLY:

To learn more about our employment opportunities, visit us at www.aetna.com and enter Requisition #12114 on the job search page.

 

We conduct pre-employment drug and background testing.

No agencies, please.

Aetna is an equal opportunity/affirmative action employer.