Aetna Medicare Clinical Pharmacy Program Manager in Arlington, Texas

Req ID: 52102BR

Please note: This is a full time, work at home position that can be worked anywhere in the US

POSITION SUMMARY

This role will provide a variety of clinical and operational support to ensure that business objectives are met within the Medicare Precert department. This position works closely with functional area managers to facilitate appropriate and timely approval of pharmacy requests based on established clinical criteria.

Fundamental Components:

  • Develops and maintains internal department work aids, job aids, and clinical references to ensure consistent and appropriate drug reviews and satisfy the compliance requirements of Medicare. Participates in formulary or benefit discussions.

  • Develops innovative solutions to streamline workflows or processes for internal and external teams. Ensures project implementations adhere to best practices for optimized quality of member care and reduced healthcare costs.

  • Acts as subject matter expert for clinical pharmacy issues within Precert area (i.e. drug reviews, training/education, quality assurance, compliance interpretation, pharmaceutical and therapeutic research, and work aid builds).

  • Maintains a solid understanding of Medicare Chapter guidance and remain current with medication knowledge and best practice protocols.

  • Provides on-going department support in research and analysis essential to resolving operational and quality concerns/issues raised by providers and other internal/external departments.

  • Interact effectively with other departments to achieve business goals.

  • Conducts coverage determination reviews or other duties as required.

    BACKGROUND/EXPERIENCE desired:

    Current unrestricted state license required.

    Bachelors degree from an accredited school of pharmacy or Pharm. D. from an accredited school of pharmacy required. Previous (5+ years) clinical pharmacy experience required.

    3+ years of managed care experience is required

    Strong clinical experience with experience in pharmacology and therapeutics knowledge base is required

    Previous experience in Pharmacy Benefit Management environment preferred.

    Call center experience preferred

    CMS chapter guidance experience is strongly preferred

    EDUCATION

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

    LICENSES AND CERTIFICATIONS

    Pharmacy/Registered Pharmacist is required

    FUNCTIONAL EXPERIENCES

    Functional - Communications/Provider communications/4+ Years

    Functional - Customer Service/Customer Service - Pharmacy/4+ Years

    TECHNOLOGY EXPERIENCES

    Technical - Desktop Tools/TE Microsoft Excel/4+ Years/

    Technical - Desktop Tools/Microsoft Word/4+ Years/

    Technical - Database/Microsoft Access/1+ Years/

    Telework Specifications:

    Full-Time Telework (WAH) considered for any US location; training period in the office may be required

    ADDITIONAL JOB INFORMATION

    Must be a licensed pharmacist with an RPh or Pharm D degree.

    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