Pharmacist, Clinical Retrospective Case Mgmt - Archimedes

The Pharmacist, Clinical Retrospective Case Management will be divided into two areas: external clinical outreach activities related to high-cost case management and prior authorization of specialty medications, across pharmacy and medical benefits and specialty and traditional drugs. In addition, this role will have the opportunity to evaluate the data to identify actionable opportunities for specialty management and create clinical policies.

The Pharmacist, Clinical Retrospective Case Management is responsible for being the clinical expert for all specialty medications across both the pharmacy and the medical benefit. This role will be able to successfully communicate with physicians, nurses, pharmacists, and members related to high-cost case concerns, dose management, genetic testing, therapeutic substitutions and cost management related to specialty drugs. Clinical subject matter expert is required to conduct peer to peer consultations with physicians.

Ability to work onsite at our location in St. Louis, MO preferred. Hybrid environment available (in office 3 days a week).

How do I make an impact on my team?

Review and interpret client data to identify, develop, and manage high-cost clinical interventions and casework.
• Evaluate clinical research and financial data to develop strategic medication management options and coverage recommendations.
• Manage retrospective case requests in compliance with established clinical criteria.
• Assist in the development of clinical policies and pharmacy benefit management programs.
• Contribute to clinical program development for both medical and pharmacy benefits.
• Complete claims editing and audits to ensure accuracy and compliance.
• Develop and deliver clear, data-driven clinical messages to physicians, members and other clinicians.
• Serve as a peer-to-peer consultant, effectively presenting complex clinical and cost-effectiveness information to various stakeholders.
• Define, document, and present results of clinical interventions and programs to plan sponsors.
• Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.
• Other duties as assigned.

What our team expects from you?

• Education: Doctor of Pharmacy (PharmD) required.

• Certification/Licenses: Current pharmacist license (RPh) in good standing with a State Board of Pharmacy required. Board of Pharmacy certification preferred for Pharmacotherapy, Ambulatory Care or Oncology Care.

• Experience:
  • Pharmacy and Medical specialty benefit knowledge and experience required.
  • 3 years clinical or managed care experience or Clinical/Managed Care Pharmacy Residency preferred.
  • Proficient in Microsoft Excel, Power Point and Word.

What can you expect from Archimedes?

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program - up to $750!

#LI-Onsite