Lumeris Clinical Pharmacist in St. Louis, Missouri
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The Clinical Pharmacist will provide medication therapy management (MTM) services for a Medicare Advantage population including one-on-one phone based consultations with members. Additional responsibilities include interfacing with the PBM, developing and analyzing pharmacy utilization reports, supporting the Pharmacy and Therapeutics Committee, processing Part B medication authorization requests, and participating as a member of an interdisciplinary care management team.
Role and Responsibilities
Perform medication reviews of members meeting Medicare Part D MTM eligibility criteria, develop pharmacotherapy plans of care and communicate plans to members and providers, as applicable.
Provide one-on-one phone based MTM consultations with members at member request.
Engage with members, care-givers, and providers to optimize drug treatment plans.
Document MTM interventions and assist with reporting MTM data elements as required by CMS.
Interface with the PBM on the coverage determination process reviewing pharmacy appeals/grievances, claims, and formulary maintenance.
Process authorization requests for Part B medications.
Assist in the development and support of quality and utilization improvement programs aimed at improving adherence as well as safe and effective medication use.
Assist in the development and analysis of pharmacy utilization reports at a physician group level and physician-specific level. Make recommendations on ways to optimize pharmacotherapy utilization.
Develop written policies and procedures for the delivery of clinical pharmacy services.
Participate in care management as a member of an interdisciplinary care team.
Maintain HIPAA standards and ensure confidentiality of protected health information.
Ensure compliance with all state and federal regulations and guidelines in day-to-day activities.
Perform special projects as assigned.
Experience, Qualifications, and Education
BS in Pharmacy, Pharm.D. preferred, with active pharmacist’s license in good standing
Minimum of two years clinical experience preferably in managed care or ambulatory care or successful completion of one or two years post-doctoral residency/fellowship
Medicare experience preferred
Knowledge, skills, and ability required:
Excellent verbal and written communication skills
Ability to effectively and efficiently discuss clinical information regarding medications from all sources (prescription, over-the-counter, herbal, etc.) in patient-friendly language.
Strong decision making skills
Ability to develop reports, analyze and interpret data
Excellent customer service skills
Excellent computer skills including Microsoft Office
Ability to multi-task and self-motivate
REPORTS TO: Vice President of Health Services
Lumeris is an EEO/AA employer M/F/V/D.
St. Louis, MO
Join Our Growing Team!
Lumeris is a value-based care managed services operator for health systems and providers seeking extraordinary clinical and financial outcomes. Lumeris aligns providers and payers across populations with technologies, processes, behaviors and information to achieve high-quality, cost-effective care with satisfied consumers — and engaged physicians.
Lumeris with Essence Healthcare, its inaugural client and learning laboratory with more than 60,000 Medicare members in Missouri and Illinois, has averaged a CMS rating of 4.5 Stars for the last ten years and produced the highest consumer and physician satisfaction scores in the industry along with significantly better clinical outcomes and lower costs. For more information, go to www.lumeris.com.
Why Join Lumeris?
At Lumeris, you will be part of team that is focused on solving the nation’s healthcare problem, and you will be able to contribute to our purpose. Our environment is fast-paced, change-oriented and focused on growth and employee engagement. At Lumeris, we know that talent is best utilized when given the opportunity to succeed. That is why we have removed the boundaries that inhibit success and focus on fostering an environment that allows employees to utilize their talents.