[Hiring] Clinical Pharmacist, Pharmaceutical Services Consultant @Conduent
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.
Role Description
The Clinical Pharmacist, Pharmaceutical Services Consultant will evaluate new-to-market medications, develop clinical recommendations, and propose utilization criteria for HCA New Mexico to support New Mexico Medicaid members.
• Proactively deliver new drug analyses and recommendations, including coverage guidance, clinical prior authorization criteria, pharmacoeconomic insights, and pharmacy practice guidelines.
• Provide ad hoc data analyses and query results to HCA New Mexico to support clinical program development and decision-making.
• Lead regularly scheduled client clinical meetings and remain available during business hours to address client questions and requests.
• Review rejected claims and provide clinical recommendations for prior authorization determinations.
• Collaborate with Retro DUR pharmacists to implement new interventions, create ad hoc reports, and address inquiries from clients, providers, and internal staff.
• Partner with the account team to update clinical interventions based on evolving treatment guidelines and evidence-based recommendations.
• Work with the IT team to ensure accurate configuration of clinical recommendations.
• Supply required data for annual CMS survey responses.
• Present clinical updates quarterly at state DUR Board meetings.
Qualifications
• PharmD degree.
• Minimum of two (2) years’ experience with Pharmacy Benefit Management, Prior Authorization processes, and knowledge of pharmacy point-of-sale systems and adjudication rules.
• Proficiency with Microsoft 365 (Word, Excel, PowerPoint, SharePoint).
Requirements
• Knowledge of Pro DUR and Retro DUR.
• Understanding of formulary management practices.
• Familiarity with FDB (First Databank).
• Medicaid program experience.
• Strong clinical data analysis skills.
Benefits
• Health and Welfare Benefits: Our health and welfare benefits can be tailored to fit you and your family's needs and start on the first day of employment.
• Retirement Savings: We will support you as you save for your future.
• Employee Discounts: We offer you access to a vast selection of global, national, and local discounts on merchandise, services, travel, and more.
• Career Growth Opportunities: We help you thrive, so together, we can grow. We provide opportunities to advance your career with a vast portfolio of businesses and a global footprint.
• Paid Training: Earn while you learn and continue to grow with access to award-winning learning platforms throughout your Conduent career.
• Paid time off: We provide attractive paid time off packages designed for you to enjoy your life away from work.
• Great Work Environment: We are proud of our award-winning culture and the recognition we’ve received for our diversity efforts.
Apply Now
Apply Now
Role Description
The Clinical Pharmacist, Pharmaceutical Services Consultant will evaluate new-to-market medications, develop clinical recommendations, and propose utilization criteria for HCA New Mexico to support New Mexico Medicaid members.
• Proactively deliver new drug analyses and recommendations, including coverage guidance, clinical prior authorization criteria, pharmacoeconomic insights, and pharmacy practice guidelines.
• Provide ad hoc data analyses and query results to HCA New Mexico to support clinical program development and decision-making.
• Lead regularly scheduled client clinical meetings and remain available during business hours to address client questions and requests.
• Review rejected claims and provide clinical recommendations for prior authorization determinations.
• Collaborate with Retro DUR pharmacists to implement new interventions, create ad hoc reports, and address inquiries from clients, providers, and internal staff.
• Partner with the account team to update clinical interventions based on evolving treatment guidelines and evidence-based recommendations.
• Work with the IT team to ensure accurate configuration of clinical recommendations.
• Supply required data for annual CMS survey responses.
• Present clinical updates quarterly at state DUR Board meetings.
Qualifications
• PharmD degree.
• Minimum of two (2) years’ experience with Pharmacy Benefit Management, Prior Authorization processes, and knowledge of pharmacy point-of-sale systems and adjudication rules.
• Proficiency with Microsoft 365 (Word, Excel, PowerPoint, SharePoint).
Requirements
• Knowledge of Pro DUR and Retro DUR.
• Understanding of formulary management practices.
• Familiarity with FDB (First Databank).
• Medicaid program experience.
• Strong clinical data analysis skills.
Benefits
• Health and Welfare Benefits: Our health and welfare benefits can be tailored to fit you and your family's needs and start on the first day of employment.
• Retirement Savings: We will support you as you save for your future.
• Employee Discounts: We offer you access to a vast selection of global, national, and local discounts on merchandise, services, travel, and more.
• Career Growth Opportunities: We help you thrive, so together, we can grow. We provide opportunities to advance your career with a vast portfolio of businesses and a global footprint.
• Paid Training: Earn while you learn and continue to grow with access to award-winning learning platforms throughout your Conduent career.
• Paid time off: We provide attractive paid time off packages designed for you to enjoy your life away from work.
• Great Work Environment: We are proud of our award-winning culture and the recognition we’ve received for our diversity efforts.
Apply Now
Apply Now