Prior Authorization Clinical Pharmacist

Aetna is a diversified health care benefits companies, providing individuals, employers, health care professionals, producers, and others with innovative benefits, products, and services. It is serving an estimated 46.7 million people with information and resources to help them make better decisions about their health care.

The position will perform clinical review of prior authorization requests, coordinate the distribution of clinical drug information, and educate providers and staff regarding the appropriate use of pharmaceutical treatment regimens. In addition, the position will support the clinical pharmacy team, supporting quality initiatives as well as other projects as needed by the line of business.

* Performs clinical review of prior authorization requests. 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. Monitors prescribing habits of participating physicians. Makes recommendations to physicians to improve medication regimens as appropriate. * Improves quality of service to members by developing programs to provide optimal pharmacy care to patients, participating in dispute resolution of drug utilization review, measuring and documenting improvements in patient care, and/or improving claim adjudication for proper provider reimbursement. * Acts as "subject matter expert" for clinical pharmacy issues (i.e., appeal, fraud, cognitive services, drug reviews, and education). 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. * Supports the Pharmacy and Therapeutics Committee function. Collaborates with other medical personnel in developing treatment guidelines and demonstrates the impact of these guidelines. May participate in formulary development and management. * Performs other duties as required.

**Background/Experience desired:** * Current unrestricted state license required. * Previous (1-3 years) clinical pharmacy experience required. Managed care experience preferred. * Understanding of medical and pharmacy terminology. * Knowledge of clinical program components, formulary designs, and prescription benefit trends. **Education** The highest level of education desired for candidates in this position is a Doctor of Pharmacy. **Licenses And Certifications** Pharmacy/Registered Pharmacist is desired **Functional Experiences** * Functional - Customer Service//1-3 Years * Functional - Communications/Provider communications/1-3 Years * Functional - Clinical / Medical/Disease management/1-3 Years **Technology Experiences** * Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User * Technical - Desktop Tools/Microsoft Word/1-3 Years/End User * Technical - Desktop Tools/TE Microsoft Excel/1-3 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** This can be a WFH position for candidates with a strong clinical/technical knowledge base and independent problem-solving skills. Pharmacist can have an RPh or Pharm.D degree