Oversees clinical management of all Experienced in clinical pharmacy PBM programs and resources program management, DUR, including the prior authorization formulary/PDL development, and program, preferred drug list, clinical Medicaid manufacturer drug rebate criteria and protocols in the call administration including Federal and centers, drug rebate programs, supplemental rebates utilization management and drug Extensive knowledge of claims utilization review programs processing systems (including Mentors pharmacy interns during Medicaid), utilization management experiential rotations programs, and drug information systems Provides drug information needed to support the Department’s clinical Drug information specialist initiatives and clinical Vermont-licensed pharmacist in good recommendations as needed. standing or licensed in another state Provide assistance to and Vendor and eligible for Vermont licensure staff on Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) coding matters pertaining to drugs Monitor drug utilization trends and make clinically and financially sound recommendations to the State Support prospective (pro-DUR) and retrospective drug utilization review activities and provider communications Provide DUR Board coordination and support Acquire, analyze, and present information regarding pharmacy benefit management practices” “best Analyze utilization data, authorization data and other clinical program data to assess the need for changes Support drug appeals as directed by the State Provides support to resolve provider issues Is expected to work on site with Department Data Responsible for all State data Extensive knowledge of Medicaid Analyst requirements and reporting needs claims processing, data management, including those that exceed the pharmacy practices, and the Vermont standard reporting package and the Medicaid program information available through the Deep familiarity with data structures of decision support tool provided by the the Vendor’s technology Vendor Provides ad hoc reporting as requested by Pharmacy Benefits Management
Oversees clinical management of all PBM programs and resources including the prior authorization program, preferred drug list, clinical criteria and protocols in the call centers, drug rebate programs, utilization management and drug utilization review programs Mentors pharmacy interns during experiential rotations Provides drug information needed to support the Department’s clinical initiatives and clinical recommendations as needed. Provide assistance to and Vendor staff on Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) coding matters pertaining to drugs Monitor drug utilization trends and make clinically and financially sound recommendations to the State Support prospective (pro-DUR) and retrospective drug utilization review activities and provider communications Provide DUR Board coordination and support Acquire, analyze, and present information regarding pharmacy benefit management “best practices” Analyze utilization data, authorization data and other clinical program data to assess the need for changes Support drug appeals as directed by the State Provides support to resolve provider issues Is expected to work on site with Department Experienced in clinical pharmacy program management, DUR, formulary/PDL development, and Medicaid manufacturer drug rebate administration including Federal and supplemental rebates Extensive knowledge of claims processing systems (including Medicaid), utilization management programs, and drug information systems Drug information specialist Vermont-licensed pharmacist in good standing or licensed in another state and eligible for Vermont licensure Data Analyst Responsible for all State data requirements and reporting needs including those that exceed the standard reporting package and the information available through the decision support tool provided by the Vendor Provides ad hoc reporting as requested by Pharmacy Benefits Management Extensive knowledge of Medicaid claims processing, data management, pharmacy practices, and the Vermont Medicaid program Deep familiarity with data structures of the Vendor’s technology
vermont-pbm-rfp-amended-1-9-14.docx