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Form of workAmTrust Financial Services, a fast-growing commercial insurance company, has a need for a Clinical Pharmacist. This role is out of one of our office locations in the United States on a hybrid schedule.
PRIMARY PURPOSE: The Clinical Review Pharmacist has the responsibility of reviewing the medical necessity, appropriateness, and quality in the appropriate setting for workers' compensation injured employee as it pertains to their medications. Additionally, they will work with Amtrust adjusters and nurses to take proper interventions in the care of the injured employee. This position primarily requires timely reviews of pharmacy prior authorizations to determine appropriateness and medical necessity of treatment. This position assesses the medical appropriateness of proposed medications for our injured employees and partners with the AmTrust claims team to expedite medically necessary treatment.
Responsibilities- Review prescription prior authorizations in the timeliest manner.
- Document medication determination based on professional clinical judgement, evidence-based guidelines, clinical treatment guidelines, state specific workers' compensation formularies, and third-party Utilization Review when appropriate.
- Document judgement on medication determinations on multiple platforms.
- Recommend to the appropriate party alternative medications, alternative dosing, or other modifications (including discontinuation of medications) as appropriate.
- Reviews therapy plans with case nurses as needed.
- Escalate cases for multi-disciplinary reviews.
- Telephonic engagement with providers for peer-to-peer interventions
- Participate in clinical quality audits for inter-rater reliability assurance and support
- Pharmacists review medication orders for completeness, accuracy, and legality, determining the presence of medication therapy problems in a patient's current medication therapy, including, for example, any of the following:
- Medication prescribed inappropriately for a particular medical condition
- Current medication therapy regimen is inappropriate (dose, dosage form, duration, schedule, route of administration, method of administration)
- There is therapeutic duplication
- Provide pharmacological information by answering questions and requests of health care professionals and adjusters
- Maintain privacy and confidentiality of all records while adhering to ethical, legal, and regulatory standards.
- Ability to work independently and prioritize workload
- 3+ year of experience in pharmacy clinical care
- Pharmacy B.S or Pharm D
- Strong documentation skills
- Strong communication and presentation skills
Preferred experience:
- Prior Authorization
- Pain management treatment protocols and clinical guidelines
- Excellent oral and documentation communication skills
- MTM certifications
- Workers' compensation managed care treatment
- Clinical guidelines and formulary management
AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.
AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.
AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.
Employment Type: FULL_TIME
