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Medicare Part D Pharmacy Resident in Southfield, MI at AF Group

Date Posted: 11/30/2018

Job Snapshot

Job Description



SUMMARY:

The purpose of the Medicare Part D PGY1 residency program is to empower and educate the resident in all areas of Medicare Part D practice, including but not limited to:

  • Formulary Management (including Rebates)
  • Pharmacy and Regulatory Compliance and Audit
  • Pharmacy Benefits Management
  • Clinical Pharmacy Programs
  • Plan Performance and Quality Assurance
  • Medicare Part B and D Prior Authorizations and Appeals
  • Product Development
  • Administration and Leadership



RESPONSIBILITIES/TASKS:

  • Assist Senior Leadership in the planning, development, and implementation of Medicare Part D products, programs, and services such as submission of the CMS bid
  • Help to develop, implement and maintain utilization management and drug utilization review programs
  • Serve as a key clinical support person for processing drug information inquiries
  • Participate in the Pharmacy & Therapeutics committee, making both clinical and financial formulary recommendations.
  • Develop, implement and continually update physician and patient educational materials.
  • Work with various internal departments to develop sound clinical programs as well as monitor and report effectiveness and overall cost savings related to these programs.
  • Promote appropriate prescribing behavior among BCBSM participating physicians for the Medicare Part D population
  • Propose, plan, execute, and review quality assurance activities related to medication reconciliation, academic detailing and controlled substance clinical reviews.
  • Assist with oversight of the Part D Medication Therapy Management program, including vendor management and MTM program submission to CMS
  • Prepare, review and conduct presentations and/or continuing education programs to various audiences, including providers and internal pharmacy and medical staff
  • Assist with internal and CMS audits, and other Part D operational areas, such as transition monitoring and 1/1 readiness
  • Review of prior authorizations for drugs covered under Medicare Parts D and B
  • Participation in the development and execution of initiatives to improve the Medicare Stars quality measures, especially focusing on medication adherence programs
  • Completion of a pharmacy research project, including a poster presentation
  • Collaborate with the formulary team to help with the drug rebate program, formulary development and the Coverage Determinations, Appeals and Grievance process
  • Assist with the Part D component of Requests for Proposals from prospective client groups.
  • Identify opportunities for improvement in clinical programs based on data analysis
  • Aid in the management of high-cost specialty medications
  • Actively participate in the education of pharmacy students, both as a lecturer at the Wayne State University College of Pharmacy, and by precepting pharmacy interns and students on rotation
  • Other duties as assigned