Clinical Pharmacist, Pharmaceutical Services Consultant
The Clinical Pharmacist, Pharmaceutical Services Consultant will evaluate new-to-market medications, develop clinical recommendations, and propose utilization criteria for HCA New Mexico to support New Mexico Medicaid members.
Responsibilities
• Proactively deliver new drug analyses and recommendations, including coverage guidance, clinical prior authorization criteria, pharmacoeconomic insights, and pharmacy practice guidelines.
• Provide ad hoc data analyses and query results to HCA New Mexico to support clinical program development and decision-making.
• Lead regularly scheduled client clinical meetings and remain available during business hours to address client questions and requests.
• Review rejected claims and provide clinical recommendations for prior authorization determinations.
• Collaborate with Retro DUR pharmacists to implement new interventions, create ad hoc reports, and address inquiries from clients, providers, and internal staff.
• Partner with the account team to update clinical interventions based on evolving treatment guidelines and evidence-based recommendations.
• Work with the IT team to ensure accurate configuration of clinical recommendations.
• Supply required data for annual CMS survey responses.
• Present clinical updates quarterly at state DUR Board meetings.
Requirements
• PharmD degree.
• Minimum of two (2) years’ experience with Pharmacy Benefit Management, Prior Authorization processes, and knowledge of pharmacy point-of-sale systems and adjudication rules.
• Proficiency with Microsoft 365 (Word, Excel, PowerPoint, SharePoint).
Preferred Qualifications
• Knowledge of Pro DUR and Retro DUR.
• Understanding of formulary management practices.
• Familiarity with FDB (First Databank).
• Medicaid program experience.
• Strong clinical data analysis skills.
Flexible Working
At Conduent, we want you to be yourself. We recognize that everyone is different and that how people want to work and deliver at their best is different for everyone, too.
In this role, you can expect the following working conditions:
Remote work: Work in a way that allows you to work from home and have time onsite when needed to connect with other team members and business leaders.
Working For You
Perks and rewards designed for you:
• Health and Welfare Benefits: Our health and welfare benefits can be tailored to fit you and your family's needs and start on the first day of employment.
• Retirement Savings: We will support you as you save for your future.
• Employee Discounts: We offer you access to a vast selection of global, national, and local discounts on merchandise, services, travel, and more.
• Career Growth Opportunities: We help you thrive, so together, we can grow. We provide opportunities to advance your career with a vast portfolio of businesses and a global footprint.
• Paid Training: Earn while you learn and continue to grow with access to award-winning learning platforms throughout your Conduent career.
• Paid time off: We provide attractive paid time off packages designed for you to enjoy your life away from work.
• Great Work Environment: We are proud of our award-winning culture and the recognition we’ve received for our diversity efforts.
Join Us
At Conduent, we are one team, one mission. We understand that our success is directly related to the success of our associates.
We strive to create a culture where you can:
• Bring your authentic self to work
• Grow and thrive, both personally and professionally
• Make a difference with our clients, our communities, and the millions of people we support.
When you join Conduent, you are engaged in creating the future - both our company’s and your own. With more than 60,000 associates across 24 countries, we will provide you the opportunity to grow with a team of people who will challenge and inspire you to be the best!
Pay Transparency Laws in some locations require disclosure of compensation and/or benefits-related information. For this position, actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, Conduent provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation and/or sick time. The estimated salary range for this role is $100,100 - $130,000.
Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.
Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.
For US applicants: People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by submitting their request through this form that must be downloaded: click here to access or download the form. Complete the form and then email it as an attachment to [email protected]. You may also click here to access Conduent's ADAAA Accommodation Policy.
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Responsibilities
• Proactively deliver new drug analyses and recommendations, including coverage guidance, clinical prior authorization criteria, pharmacoeconomic insights, and pharmacy practice guidelines.
• Provide ad hoc data analyses and query results to HCA New Mexico to support clinical program development and decision-making.
• Lead regularly scheduled client clinical meetings and remain available during business hours to address client questions and requests.
• Review rejected claims and provide clinical recommendations for prior authorization determinations.
• Collaborate with Retro DUR pharmacists to implement new interventions, create ad hoc reports, and address inquiries from clients, providers, and internal staff.
• Partner with the account team to update clinical interventions based on evolving treatment guidelines and evidence-based recommendations.
• Work with the IT team to ensure accurate configuration of clinical recommendations.
• Supply required data for annual CMS survey responses.
• Present clinical updates quarterly at state DUR Board meetings.
Requirements
• PharmD degree.
• Minimum of two (2) years’ experience with Pharmacy Benefit Management, Prior Authorization processes, and knowledge of pharmacy point-of-sale systems and adjudication rules.
• Proficiency with Microsoft 365 (Word, Excel, PowerPoint, SharePoint).
Preferred Qualifications
• Knowledge of Pro DUR and Retro DUR.
• Understanding of formulary management practices.
• Familiarity with FDB (First Databank).
• Medicaid program experience.
• Strong clinical data analysis skills.
Flexible Working
At Conduent, we want you to be yourself. We recognize that everyone is different and that how people want to work and deliver at their best is different for everyone, too.
In this role, you can expect the following working conditions:
Remote work: Work in a way that allows you to work from home and have time onsite when needed to connect with other team members and business leaders.
Working For You
Perks and rewards designed for you:
• Health and Welfare Benefits: Our health and welfare benefits can be tailored to fit you and your family's needs and start on the first day of employment.
• Retirement Savings: We will support you as you save for your future.
• Employee Discounts: We offer you access to a vast selection of global, national, and local discounts on merchandise, services, travel, and more.
• Career Growth Opportunities: We help you thrive, so together, we can grow. We provide opportunities to advance your career with a vast portfolio of businesses and a global footprint.
• Paid Training: Earn while you learn and continue to grow with access to award-winning learning platforms throughout your Conduent career.
• Paid time off: We provide attractive paid time off packages designed for you to enjoy your life away from work.
• Great Work Environment: We are proud of our award-winning culture and the recognition we’ve received for our diversity efforts.
Join Us
At Conduent, we are one team, one mission. We understand that our success is directly related to the success of our associates.
We strive to create a culture where you can:
• Bring your authentic self to work
• Grow and thrive, both personally and professionally
• Make a difference with our clients, our communities, and the millions of people we support.
When you join Conduent, you are engaged in creating the future - both our company’s and your own. With more than 60,000 associates across 24 countries, we will provide you the opportunity to grow with a team of people who will challenge and inspire you to be the best!
Pay Transparency Laws in some locations require disclosure of compensation and/or benefits-related information. For this position, actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, Conduent provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation and/or sick time. The estimated salary range for this role is $100,100 - $130,000.
Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.
Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.
For US applicants: People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by submitting their request through this form that must be downloaded: click here to access or download the form. Complete the form and then email it as an attachment to [email protected]. You may also click here to access Conduent's ADAAA Accommodation Policy.
Apply tot his job
Apply To this Job