Utah Medicaid Pharmacist DHHS

About the job

Utah Medicaid Pharmacist to support the development, implementation, and oversight of pharmacy coverage policy and prior authorization programs. This position is responsible for reviewing and developing coverage policies, creating and maintaining clinical prior authorization criteria, evaluating prior authorization requests to ensure alignment with clinical guidelines and program requirements, and participating in clinical programs and related processes to help ensure Medicaid members have access to safe, effective, and appropriate medications. Key responsibilities and day to day responsibilities of this position: Develop, implement, and maintain pharmacy coverage policies and clinical prior authorization criteria. Review and evaluate prior authorization requests for clinical appropriateness, and necessity. Perform comprehensive clinical reviews by evaluating patient information against established policy criteria, clinical guidelines, and evidence-based recommendations. Evaluate and interpret clinical literature, treatment guidelines, and emerging evidence to support policy and coverage decisions. Analyze pharmacy and medical claims data to identify trends and opportunities to improve the Medicaid pharmacy program. Participate in clinical programs such as Drug Utilization Review (DUR), provider outreach, and peer-to-peer education. Communicate prior authorization determinations clearly and professionally to providers and members. Collaborate with internal teams and contribute to workgroups to support program initiatives and process improvements. Maintain accurate documentation of reviews, decisions, and supporting information to ensure a complete and compliant audit trail. Contribute to process improvement efforts by identifying opportunities to streamline workflows and enhance program effectiveness. Support assigned projects and initiatives within established timelines. Remain current on clinical information, drug therapies, and Medicaid pharmacy program requirements. Triage incoming phone calls from providers specific to prior authorization decisions. Perform other related duties as assigned. Supplemental Information Licensure to practice pharmacy in the state of Utah. 58-17b-303 License required -- Licensure classifications for individuals. (1) A license is required to engage in the practice of pharmacy An offer of employment will be contingent on the applicant successfully passing a DHHS background check. This position is currently a hybrid of two (2) days in-office and three (3) remote work days. Please note, a position's eligibility for remote work is established by agency management and is subject to change at their discretion, at any time, and for any reason. Effective July 1, 2021, State of Utah Employees must either reside in Utah or be in the process of relocating to Utah within 30 days of their start date. Risks which require the use of special safety precautions and/or equipment, e.g., working around operating machines, working with contagious diseases or hazardous chemicals, etc. Typically, the employee may sit comfortably to perform the work; however, there may be some walking; standing; bending; carrying light items; driving an automobile, etc. Special physical demands are not required to perform the work.