Aetna Clinical Pharmacist in Moon township, Pennsylvania

Req ID: 45497BR

POSITION SUMMARY

Our position reviews appeals for Medicare Part D. We review Medicare approved compendia for medically accepted uses of medications and do outreach to members and providers for clinical information necessary to complete appeal reviews.

  • Occasional Weekend and Holidays will be required as well as some evening work.

    Fundamental Components:

  • Performs clinical review of medication appeal requests for Medicare Part D. Utilizes clinical experience and skills in a collaborative process to apply the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render appropriate coverage determination.

  • Make recommendations to physicians to improve medication regimens as appropriate.

  • Improves quality of service to members by providing optimal pharmacy care to patients, participating in dispute resolution of drug utilization review, communicate as necessary to members and providers concerning appropriate coverage of medication and alternatives.

    -Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Educates providers and staff regarding the appropriate use of pharmaceutical treatment regimens. May develop and maintain training documents for staff development.

  • Performs other duties as required.

    BACKGROUND/EXPERIENCE desired:

    Current unrestricted state Pharmacy/Registered Pharmacist (RPh) license is required

    Understanding of medical and pharmacy terminology mandatory.

    Previous (1+ years) clinical pharmacy experience preferred.

    Maximus or IRE (Independent Review Entity) experience is a plus

    Managed care experience preferred.

    Oncology or Transplant Center experience preferred

    EDUCATION

    The minimum level of education desired for candidates in this position is a Doctor of Pharmacy.

    LICENSES AND CERTIFICATIONS

    Pharmacy/Registered Pharmacist (RPh) is required

    FUNCTIONAL EXPERIENCES

    Functional - Customer Service/Customer Service - Pharmacy/1+ Years

    Functional - Communications/Provider communications/1+ Years

    Functional - Communications/Member communications/1+ Years

    TECHNOLOGY EXPERIENCES

    Technical - Desktop Tools/Microsoft Outlook/1+ Years/End User

    Technical - Remote Access/WAH (Work at Home)/1+ Years/End User

    Technical - Operating Systems/Windows/1+ Years/End User

    Technical - Remote Access/Broadband VPN/1+ Years/End User

    Telework Specifications:

    Full-Time Telework (WAH)

    Considered for any US location; training period in the office may be required

    ADDITIONAL JOB INFORMATION

    Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

    We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

    Together we will empower people to live healthier lives.

    Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

    We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

    Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

    We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

    Together we will empower people to live healthier lives.

    Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

    We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

    Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

    Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Health Care