Pillarrx consulting is seeking a consulting pharmacist to lead and support health plan and employer group clients with clinical needs and requestsExperience with pbm account management and government programs is required.
Combining nearly 50 years of pharmacy benefit management experience, pillarrx is a leading firm dedicated to delivering pharmacy benefit consulting, auditing, and copay assistance servicesPillarrx 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 contractWe provide best-in-class, value-based pharmacy solutions utilizing 100% review of your pharmacy claimsOur practical compliance guidance can help you maximize your financial outcomes, eliminate pharmaceutical waste & abuse, and increase member satisfaction.
The consulting pharmacist will provide clinical insight, guidance and recommendations to clients based on reviewing formularies, client reporting, industry trends, new drug releases and moreIn 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 businessWill 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.eMedicare star ratings or hedis measures), as requested
Support delegation audits
Review and provide consultative insight to clinical-related reporting (i.eLarge 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.gMedicare part d, medicaid and exchange
Proficient microsoft office suite skills, e.gWord, 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, firstname.lastname@example.org