Pharmacist Clinical - Resident

The Pharmacist Clinical - Resident supports Amerigroup pharmacy program operations for Medicaid and Medicare members in Puerto Rico. The role focuses on daily clinical prior authorizations, Medication Therapy Management (MTM), Lock-in, Drug Utilization Review (DUR), and Pharmacy and Therapeutics Committee work including therapeutic class reviews and formulary recommendations.

• Performs daily clinical prior authorizations and coverage determinations for Medicaid and Medicare
• Supports Pharmacy and Therapeutics Committee deliverables (therapeutic class reviews, policy review, drug monographs, formulary recommendations)
• Participates in Medication Therapy Management (MTM), Lock-in, and Drug Utilization Review (DUR) programs
• Reviews member profiles and recommends members for lock-in, case management, or disease management
• Responds to and resolves member/provider complaints, claims processing issues and appeals

This is a managed care pharmacy role emphasizing clinical utilization management and formulary-related processes rather than software engineering. Core workflows include coverage determinations, DUR/lock-in program activities, pharmaceutical care management based on member profile review, and resolving complaints and appeals.

The ideal candidate is a pharmacist resident with managed care experience who can perform daily clinical prior authorizations and coverage determinations for Medicaid and Medicare. They are a Pharmacy graduate who can obtain a current valid state license as a Registered Pharmacist (RPh) within 90 days and support Pharmacy and Therapeutics Committee activities including therapeutic class reviews and formulary recommendations.

Required