The pharmacist performs concurrent drug utilization review with program instructions and general pharmacy information using the point-of-sale computer system established by the West Virginia Bureau of Medical Services (WVBMS). Reviews and manages the information
provided to providers by the program’s non-professional personnel. Provides professional services to the WVBMS as directed by the Unit Coordinator of the Rational Drug Therapy Program.
Duties & Responsibilities
Responsibilities are professional in nature, and are performed under supervision. Specific tasks include, but are not limited to:
1) Reviews individual inquiries and uses clinical decision making skills and therapeutic judgment to determine if claim payment can be approved by using the following guidelines:
a. Reviews patient medication profiles in order to determine the clinical appropriateness of the inquiry, taking into consideration drug-drug, drug-age interactions, duplication of therapies, medical necessity, and other issues which may affect the clinical
outcome of the patient. Offers and documents explanations for inquiries that cannot be paid.
b. For non-complex requests: uses established guidelines and enters approved requests into the mainframe computer.
c. For complex requests: reviews texts, journals, and/or other references to determine if a claims can be approved. Enters approved requests into the mainframe computer.
d. Offers and documents explanations for denials based on current program guidelines and pharmaceutical care issues. Provides alternative recommendations based on anticipated patient outcomes and cost effective results.
e. Maintains patient confidentiality in accordance to WVU and Federal HIPPA Laws.
2) Initiates research to gather and evaluate information from various references to perform prospective drug utilization reviews. Demonstrates proficiency in gathering information from various sources including, but not limited to:
a. Texts and references within the program and University libraries
b. Med-line search program
d. References which providers and manufacturers present for review. Evaluates the reliability of sources by identifying potentially skewed or biased information.
3) Acquires and maintains clinical knowledge and information on the disease states in which the program is involved and on the drug utilization review process as it pertains to disease states in which the program is involved.
4) Technician Supervision
a. Reviews inquiries from technical employees of the program and ascertains the clinical
appropriateness of the outcome in comparison to the drug utilization evaluation against which the inquiry is being presented. Averts inappropriate outcomes and educates the technical employee when applicable.
Supervises the information being released by non-professional personnel to persons making inquiries. This is accomplished by monitoring statements made by the personnel on the phone and by reviewing all materials being sent in response to inquiries.
5) Responds to inquiries in a friendly, professional manner. Accepts calls directly or calls routed from non-other employees where the inquirer demonstrates abusive, belligerent behavior. Makes a reasonable attempt to converse constructively with the inquirer.
Documents all disconnects or other actions. Refers all inquires outside the scope of knowledge of the program to appropriate sources when and where possible.
6) Serves as a source of information about the program to individuals making inquiries. Distributes informational guidelines and provides information to substantiate decisions made by the program in order to establish credibility for the program and to educate
the individual making the inquiry. Composes correspondence on a wide range of subjects relating to the program.
7) Other Duties
Assists in the orientation and training of all new professional and non-professional personnel. Ascertains when employee is prepared to participate in the drug utilization review process and assists when any questions arise.
a. Assists in the orientation, training, and education of all student externs rotating through the program. Answers questions in a courteous and educational manner. Ascertains when the student is prepared to participate in the drug utilization review process
and assists when any questions arise.
b. Participates in and assures the completion of the daily “housekeeping” duties of the program. These include but are not limited to: a) daily report, b) faxing, c) data entry, d) comfort issues, e) computer backup/maintenance, etc.
c. Attends meetings where applicable and when staffing allows
d. Performs other professional duties and/or responsibilities as assigned by RDTP Unit Coordinator.
This position reports to the Unit Coordinator of the Rational Drug Therapy Program.
Job is physically comfortable; individual is normally seated and has discretion of walking, standing, etc. May occasionally lift light-weight objects weighing less than 25 pounds. Work will require daily use of microcomputer, keyboard, printer, fax, copier,
telephone, and other related office equipment. Incumbent must have good hand/eye coordination and excellent speech patterns.
Works in standard office atmosphere with shared space and equipment. Incumbent is responsible to know and comply with all safety procedures. Travel within the tri-state area may be required and will involve driving and possible airplane travel.
Education and/or Experience
1) PharmD degree from an accredited School of Pharmacy;
2) Retail or hospital pharmacy experience;
3) An equivalent combination of education and experience.
Certifications, Licenses, Registrations
1) WV Board of Pharmacy License or ability to acquire such license.
Skills, Knowledge, Abilities
1) Demonstrated ability to make valid clinical judgments concerning a patient’s drug therapy needs, given the guidelines of the program
2) Demonstrated excellent verbal and written communication skills
3) Demonstrated ability to work as a team player and make constructive suggestions to appropriate peers and supervisors
4) Exhibits excellent customer service skills and orientation
5) Exhibits excellent skills in handling difficult persons
6) Must be a WV licensed pharmacist or eligible for WV Licensure
7) Demonstrates knowledge of appropriate drug use in most common disease states
8) Exhibits a strong understanding of retail pharmacy operations and insurance billing processes associated with retail pharmacy operations.
9) Demonstrated excellent computer data entry, software (Window’s based), and typing skills.
10) Ability to follow guidelines and convey information in an accurate manner.
11) Exhibits the flexibility and the ability to work with different insurance plans with different guidelines.
12) Demonstrates ability to perform duties in compliance with WVU HIPAA and patient confidentiality requirements
1) Technical skills – Strives to continuously build knowledge and skills; pursues training and development opportunities; assess strengths, weaknesses, and shares expertise with others.
2) Problem solving – Gathers and analyzes information, identifies problems, develops alternatives, uses reason even when dealing with emotional topics and works well in groups and resolves matters timely.
3) Internal & External Customer Service – Manages difficult or emotional matters with objectivity and openness; responds promptly to needs and requests for service and assistance; meets commitments and dates, notifies others if change occurs; provides, solicits
and applies feedback; and builds goodwill through balanced contributions, positive approach, respect and support of others.
4) Communications – Demonstrates group presentation skills, participates in meetings, listens and gets clarification, is responsive and speaks clearly and persuasively in positive and negative situations. Writes and edits clearly and informatively, varies style
to meet needs, presents numerical data effectively, and able to read and interpret written information. Demonstrates the ability to appropriately document patient information in acceptable medical documentation format.
5) Organizational Support – Aligns work and develops strategies to meet organizational goals; seeks to improve and promote quality; demonstrates accuracy and thoroughness; and upholds organizational expectations and values.
6) Self-Management – Responds to management direction; resourcefully adapts to changes in work environment and circumstances; responds well under pressure and manages competing demands; takes calculated risks, asks for and offers help when needed; exercise
discretion and sound judgment; is tactful and responsible for own actions. Adheres to work schedule and complies with leave management responsibilities.
Preferred Qualifications & Credentials
Certifications, Licenses, Registrations
1) Clinical pharmacy practice is preferred.
- AA/EOE/Minorities/Females/Vet/Disability/E-Verify Compliant Employer.
- Please view Equal Employment Opportunity Posters provided by OFCCP
- The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access
to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure
is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information.
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