Job Category: Other
Combining nearly 50 years of pharmacy benefit management experience, PillarRx is a leading firm dedicated to delivering pharmacy benefit consulting, auditing, and copay assistance services. PillarRx assists health plans, municipalities, self-funded entities, business coalitions and Taft Hartley plans.
Our qualified professionals lead all aspects of the pharmacy benefit program, helping our customers save money, minimize compliance risks, and refine their PBM contract. We provide best-in-class, value-based pharmacy solutions utilizing 100% review of your pharmacy claims. Our practical compliance guidance can help you maximize your financial outcomes, eliminate pharmaceutical waste & abuse, and increase member satisfaction.
We are currently seeking a Consulting Pharmacist to lead and support health plan and employer group clients with clinical needs and requests. The Consulting Pharmacist will provide clinical insight, guidance and recommendations to clients based on reviewing formularies, client reporting, industry trends, new drug releases and more. In addition, the position supports Government Program initiatives that require clinical expertise including, but not limited to, the support of Medicare Part D, Medicaid and Exchange lines of business. Will lead or support clinical projects/programs that are requested by clients.
The Consulting Pharmacist can work remotely, but we are targeting candidates on the East coast or in the Midwest regions, as they will primarily serve clients in these areas.
Essential Duties and Functions:
- Be a clinical resource to the Consulting team and clients, as needed
- Maintain PillarRx’s specialty drug list
- Support clients with weekly, monthly and annual formulary updates, including new drug recommendations
- Identify cost, utilization, and quality trends across business clientele, assisting in the development of larger company strategies to address new/emerging trends
- Understand and provide expertise in the specific formulary requirements as established for commercial, Medicare, Exchange and Medicaid health plans
- Responsible for monthly and annual formulary submissions to CMS for all custom Medicare clients
- Support clients’ quarterly P&T committee meetings, as required
- Support drug coverage determinations/exceptions/appeal process
- Support the monthly Prior Authorization/Coverage Determination audits
- Support clients with any quality measure initiatives (i.e. Medicare Star Ratings or HEDIS measures), as requested
- Support Delegation Audits
- Review and provide consultative insight to clinical-related reporting (i.e. Large Case Reporting, Adherence Reporting, Opioid Overutilization Reporting, Client Monthly and Quarterly program reporting, etc.)
- Assist in creating the monthly pharmacy newsletter to be distributed to the internal teams for sharing with the clients and industry partners
- Support marketing material as needed to provide blog content and other information to educate and generate interest in PillarRx
- Support IPC Copy Assistance Program, as needed
- This position will include job duties that require risk designations for access to Electronic Protected Health Information (PHI) in the course of their job responsibilities
- Other duties as assigned
- Bachelor of Science in Pharmacy, Doctor of Pharmacy
- Active pharmacist license in good standing with no previous disciplinary actions in any state
- 5-10 years’ experience in consulting or managing prescription benefits
- 3-5 years’ experience in government programs, e.g. Medicare Part D, Medicaid and Exchange
- Proficient Microsoft Office Suite skills, e.g. Word, Excel, PowerPoint, etc.
- Must be willing to travel up to 25% of the time for client meetings, internal meetings, sales meetings and/or conferences
- 3-5 years of experience at a PBM in an account management role
- experience specifically managing client health plans
- Experience working with formularies, prior authorizations, and specialty pharmacy management
- Experience with medical drugs and drug rebate programs.
Raegan Osborn, [email protected]
We are an Equal Opportunity Employer. We take pride in the diversity of our team and seek diversity in our applicants.