Clinical Pharmacist

About the Role

The successful candidate will be a licensed pharmacist with a strong clinical background and excellent communication skills. You will be able to work independently and as part of a team, with a strong attention to detail and ability to prioritize tasks effectively. If you are a motivated and passionate pharmacist looking to make a difference in the lives of patients, this role could be an excellent fit for you.

Healthfirst is a leading healthcare organization that is committed to providing high-quality patient care and improving health outcomes. As a Clinical Pharmacist at Healthfirst, you will be part of a team that is dedicated to making a positive impact in the healthcare industry.

What You Will Do

• Review prior authorization requests for medications and make informed decisions based on clinical criteria
• Develop and maintain clinical criteria and medical policies for the review of medications
• Collaborate with prescribing physicians and Medical Directors to discuss clinical rationale for review decisions
• Ensure all clinical criteria is in compliance with Center of Medicare and Medicaid Services (CMS) and the New York State Department of Health (NYSDOH) regulations
• Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
• Review monthly reports and provide feedback on trends, ideas for efficiency, and innovation
• Work closely with cross-functional teams to drive business outcomes and improve patient care
• Stay current with literature, evidence-based medicine, and trends in medicine
• Participate in regulatory and compliance audits for all plans
• Ensure all activities are conducted in compliance with regulations

What We Are Looking For

• Pharmacy degree from an accredited school of pharmacy
• Registered Pharmacist in the state of New York with a license in good standing
• Minimum of 1 year experience conducting prior authorization reviews
• Strong clinical knowledge of pharmaceuticals and disease states
• Excellent written and verbal communication skills
• Ability to work well in a team environment and be a team player
• Strong critical thinking and problem-solving skills
• Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefits
• Proficiency in Microsoft Office, including Excel, Word, and PowerPoint

Nice to Have

• PGY1 Managed Care Residency
• Knowledge of regulations of the Centers for Medicare and Medicaid Services
• Ability to lead large and small working meetings
• Experience with regulatory and compliance audits

Benefits and Perks

• Competitive salary and benefits package
• Opportunity to work remotely and flexibly
• Collaborative and dynamic work environment
• Professional development and growth opportunities
• Comprehensive health insurance and retirement plan
• Paid time off and holidays
• Access to cutting-edge technology and resources
• Recognition and reward programs for outstanding performance
• Opportunities for career advancement and professional growth

• Ensure your resume and cover letter are tailored to the Clinical Pharmacist role and highlight your relevant experience and skills.
• Be prepared to discuss your clinical knowledge and experience during the interview process.
• Develop a strong understanding of regulatory requirements and compliance issues in the healthcare industry.
• Practice your communication and interpersonal skills, as these are critical for success in this role.
• Consider obtaining certifications or specialized training to demonstrate your expertise and commitment to the field.
• Research Healthfirst and the healthcare industry to demonstrate your knowledge and interest in the company and role.
• Prepare examples of your experience with prior authorization reviews, clinical criteria development, and regulatory compliance.