Clinical Consultant - Medicare Part D
Catamaran - Worcester, MA

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Serving as the primary liaison between Catamaran Rx Clinical Operations and Customer Service; providing clinical support to Client Services, Operations, IT , and Customer Service Pharmacy Technicians, claims processing system, and plan development as it relates to clinical operations; functioning as a Clinical account manager for assigned client accounts.

Responsibilities
  • Working with the client to establish achievable but aggressive clinical program goals that may include generic utilization rate improvements, the implementation of utilization programs, improvement in drug adherence rates, and disease management wrap around services.
  • Providing superior clinical consultation and account management with a focus on client retention/satisfaction and trend management.
  • Conducting utilization and cost analyses, drug utilization reviews and analyses, formulary management, and serving as a drug information resource.
  • Supporting Catamaran Rx and client specific Pharmacy and Therapeutics functions and responsibilities.
  • Providing drug information and clinical support for Customer Service Pharmacy Technicians; providing clinical input and support for claims processing programs.
  • Supporting MTM services and products, as needed.
  • Supporting corporate clinical pharmacy operations, as needed.
  • Assisting and participating in Pharmacy Student/Externship programs.
  • Analyzing claims data and the cost driver analysis report to uncover trends and patterns, and making recommendations to clients on how to intervene on those trends using UM tools and programs.
  • Analyzing existing benefit designs; understanding the implications of making various changes to the benefit design to encourage desired member behavior and financial outcomes.
  • Working with the Catamaran Rx Clinical Program Development Team to design and operationalize clinical programs with proven clinical and/or financial value.
  • Learning and representing Catamaran Rx’s product portfolio and data analytics capabilities.
  • Acting as the client’s point of contact for drug information and plan specific clinical inquiries.
  • Facilitating the delivery of market intelligence, formulary management, and P&T decisions and activity to clients.
  • Providing clinical consultation at all client meetings, especially quarterly PHASR meetings. Serves as the expert on information such as clinical program outcomes, industry best practices, book of business trends, drug pipeline activity, plan cost drivers, etc.
  • Working with account team to provide clinical strategy during client renewals.
  • Supporting elevated customer service and prior authorization inquiries specific to assigned accounts.
  • Supporting Sales and Marketing, as needed.
  • Providing education for clients, pharmacists, members, and physicians, including one-on-one physician visits and implementation of educational programs, as needed.
  • Following all policies and procedures related to job.
  • Performing other duties as assigned to meet corporate objectives.
  • Some travel may be required.

Qualifications

Bachelor’s Degree in Pharmacy or doctorate of Pharmacy (PharmD), current state pharmacy license and 2+ years pharmacy practice experience in a managed care environment, including experience developing formularies, presenting at P&T committee meetings, and performing drug utilization analyses; or equivalent combination of education and experience.

Must have strong Medicare Part D knowledge.

Strong communication, interpersonal, presentation, customer service, and computer skills required.

About this company
55 reviews
Catamaran offers a true alternative to the status quo in pharmacy benefit management. You don’t have to choose between...