Lumeris Clinical Pharmacist in St. Louis, Missouri
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The Clinical Pharmacist will use their skills and knowledge to review coverage determinations and appeals along with serving as a pharmacy subject matter expert for internal partners and monitoring the Part D benefits for the health plan.
Role and Responsibility
Manage a daily workload of both coverage review and appeals requests
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.
Participate in care management as a member of an interdisciplinary team as needed.
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 one year clinical experience preferably in managed care or ambulatory care
Medicare experience preferred
Knowledge, skills, and ability required:
Ability to organize and work to a project plan to achieve results
Strong 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 analyze and interpret data
Strong customer service skills
Strong computer skills including Microsoft Office
Ability to multi-task and self-motivate
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.