The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. If this does not apply to you please use the 'Apply' option.Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.Great Place to Work®Most Loved Workplace®Forbes Best-in-State EmployerPharmacistPRIMARY PURPOSE : To counsel physicians and patients on the proper use of medications, assist in drug selection and dosage, and monitor complex drug regimens; to provide medical necessity reviews to evaluate, implement, and monitor options and services to meet client health needs; and to promote quality cost-effective medication outcomes and alternatives.ESSENTIAL FUNCTIONS and RESPONSIBILITIESReviews complex pharmacy files and develops action plan for physicians and nurses for weaning schedule.
Evaluates need for alternative treatment through telephone contact and assessment with service provider.
Calls treating physicians to conduct a peer review of medications used on specific claims and provides insight for drug interactions, health and safety concerns, and weaning plans.
Advises patients, physicians, and other health practitioners on the selection, dosage, interactions, and side effects of medications; monitors the health and progress of patients to ensure medications are effective and are being used safely.
Consults with CPM team on difficult cases.
Consults with pharmacy UR team for difficult claims requiring weaning schedule.
Assesses needs, gives appropriate clinical options, and provides education to clients, nurse team, and treating physicians; develops specialized training for nurses to help with knowledge growth.
Negotiates price, offers generic alternatives when appropriate, and coordinates narcotic use contract with client.
Maintains accurate record system of pharmacy utilization review and complex pharmacy reviews to include cost savings, trends, and data collection.
Interacts and coordinates work of physician advisors as needed; performs complex review of cases to identify referral for case management as needed.
Participates in client meetings and phone calls to explain program results.
ADDITIONAL FUNCTIONS and RESPONSIBILITIESPerforms other duties as assigned.
Supports the organization's quality program(s).
Travels as required.
QUALIFICATIONSEducation & LicensingCurrent, active pharmacy license required. PharmD degree from an accredited college or school of pharmacy required.ExperienceTen (10) years of related experience or equivalent combination of education and experience required to include three (3) years of recent clinical practice experience. Utilization practice experience preferred. Insurance/claims industry experience preferred.Skills & KnowledgeStrong utilization practice knowledge
Knowledge of the insurance industry and claims processing
Knowledge of current pharmacy trends and alternative resources and treatments in out-patient and alternative care settings
Oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Excellent interpersonal skills
Excellent negotiation skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
WORK ENVIRONMENTWhen applicable and appropriate, consideration will be given to reasonable accommodations.Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlinesPhysical: Computer keyboarding, travel as requiredAuditory/Visual: Hearing, vision and talkingNOTE : Credit security clearance, confirmed via a background credit check, is required for this position.The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.Taking care of people is at the heart of everything we do. Caring countsSedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)