Building Location: Essentia Health Superior Belknap Pharmacy Department: 48850 Prior Authorization Job Description: The Essentia Health Pharmacist-Medication Access Services will practice in an integrated, team-based care model providing clinical support of Medication Access Services team members. Primary responsibilities include but are not limited to benefits investigation and qualification of coverage, facilitating prior authorizations (PA), evaluating and supporting appeals requests, and conducting utilization management functions. The pharmacist will collaborate with nurses, providers, and other care team members with regard to coverage of patients’ medications to achieve excellent patient care and desired outcomes.

The pharmacist will support all aspects of daily activities including monitoring and assisting in directing programs to optimize drug utilization based on different third-party plan prior authorization criteria and prescribing patterns for designated drug therapies... supporting patient assistance program (PAP) team members with regard to clinical questions and patient counseling of medications dispensed to patients under PAP; supporting clinical criteria needed for accurate Medicare Part B billing for EH retail pharmacies; training of new staff and pharmacy students; resolution of patient issues; assisting in quality improvement initiative; and other duties assigned by the Medication Access Services Pharmacy Operations Manager.

Opportunity to work in hybrid environment after 6 months, training complete, and competencies evaluated. Education Qualifications:

Key Responsibilities:
• Clinical evaluation and benefits investigation on CAM orders placed by Essentia Health Providers
• Support Medication Access Associates with clinical questions when submitting prior authorization, verifying Medicare prescription eligibility, and applying for patient assistance
• Optimize drug utilization of designated drug therapies such as specialty-lite medications
• Navigate the electronic medical record to properly determine patient qualifications for a drug per third party requirements
• Effectively communicate and collaboration with providers, nursing staff, pharmacies, third parties, and software vendor to work through claims adjudication and processing issues coverage of patients’ medications to achieve excellent patient care and desired outcomes
• Provide direct patient interaction and counseling patients with their Manufacturer-based Patient Assistance Program medications

Educational Requirements:
• Pharm.D. or B.S. Pharmacy from a college of pharmacy accredited by the American Council on Pharmaceutical Education

Required Qualifications:
• Minimum 1 year of experience as a practicing pharmacist

Preferred Qualifications:
• Successful completion of a residency program preferred
• Experience in managed care, formulary management, or medication therapy management preferred
Licensure/Certification Qualifications:

Certification/Licensure Required:
• Licensed in MN and WI or will be within 90 days of start date
FTE: 1 Shift Rotation: Day Rotation (United States of America) Shift Start Time: 0800 Shift End Time: 1630 Weekends: Holidays: No Call Obligation: No Union: Union Posting Deadline:
Essen Germany

Salary Criteria