The pharmacist is responsible of the development and management of the APS Rx Program with the objective of optimizing therapeutic outcomes by impacting drug utilization in conformity with best practices among Medicare and Medicaid accounts. Provide education to physicians for clinical initiatives, clinical cost-saving and quality improvement opportunities in conformity with quality indicators and clinical guidelines. Assist in coverage determination process in the Pharmacy Department.
Responsible for ensuring the development and implementation of the pharmacy management program and other clinical initiatives pertaining to positive outcome and cost savings that impact drug utilization in Medicare population.
Ensures the provision of education and support to physicians with regard to clinical guidelines and quality indicators to enhance their drug prescribing patterns.
Provides education for such initiatives in-person, phone calls, written materials or other interpersonal communication.
Assists to identify potential cost-savings opportunities through drug utilization reports and data analysis.
Improve department operational performance in order to achieve company goal of 95% of Pre-Authorizations evaluated in 24 hours.
Promote and implement clinical guidelines to improve approval and denial coverage determination process by call center and clinical team.
Participates as a member of a mental health care team in an interdisciplinary approach to provide quality patient care.
Monitors the pharmacy management program to evaluate the quality of clinical interventions, drug use and prescribing practices to provide high quality, cost effective therapy.
Pharmacy B.A. and/or Pharm D degree
Licensed Pharmacist in Puerto Rico
Two (2) to five (5) years of pharmacist experience
Experience in Pharmacy Benefit Management (PBM), manage care or insurance is desirable
Must demonstrate familiarity with behavioral health therapeutics and economics
Knowledge of Microsoft Office (Excel, Word, Power Point, Access)
Knowledge of Current Professional Pharmacy Practice (PR Pharmacy Law, Medicaid and Medicare)
Excellent verbal and written communication skills
Fully bilingual (Spanish and English)
Highly organized and able to work independently
Strong leadership skills