Building Location:Essentia Health Superior Belknap Pharmacy

Department:48850 Prior Authorization

Job Description:The Essentia Health Pharmacist-Medication Access Services will practice in an integrated, team-based care model providing clinical support of Medication Access Services team members in a remote setting. Primary responsibilities include but are not limited to benefits investigation and qualification of coverage, facilitating prior authorizations (PA), evaluating and supporting appeals requests, and conducting utilization management functions. The pharmacist will collaborate with nurses, providers, and other care team members with regard to coverage of patients’ medications to achieve excellent patient care and desired outcomes.

The pharmacist will support all aspects of daily activities including monitoring and assisting in directing programs to optimize drug utilization based on different third-party plan prior authorization criteria and prescribing patterns for designated drug therapies; supporting patient assistance program (PAP) team members with regard to clinical questions and patient counseling of medications dispensed to patients under PAP; supporting clinical criteria needed for accurate Medicare Part B billing for EH retail pharmacies; training of new staff and pharmacy students; resolution of patient issues; assisting in quality improvement initiative; and other duties assigned by the Medication Access Services Pharmacy Operations Senior Manager.

Education Qualifications:

Key Responsibilities:

Clinical evaluation and benefits investigation on CAM orders placed by Essentia Health ProvidersSupport Medication Access Associates with clinical questions when submitting prior authorization, verifying Medicare prescription eligibility, and applying for patient assistanceOptimize drug utilization of designated drug therapies such as specialty-lite medicationsNavigate the electronic medical record to properly determine patient qualifications for a drug per third party requirementsEffectively communicate and collaboration with providers, nursing staff, pharmacies, third parties, and software vendor to work through claims adjudication and processing issues coverage of patients’ medications to achieve excellent patient care and desired outcomesProvide direct patient interaction and counseling patients with their Manufacturer-based Patient Assistance Program medications

Educational Requirements:

Pharm.D. or B.S. Pharmacy from a college of pharmacy accredited by the American Council on Pharmaceutical Education

Required Qualifications:

Minimum 1 year of experience as a practicing pharmacist

Preferred Qualifications:

Successful completion of a residency program preferredExperience in managed care, formulary management, or medication therapy management preferred

Licensure/Certification Qualifications:

Certification/Licensure Required:

Licensed in MN, ND, or WI

Licensed in other states (MN, ND and WI) or will be within 180 days of start date

FTE:1

Possible Remote/Hybrid Option:

Shift Rotation:Day Rotation (United States of America)

Shift Start Time:

Shift End Time:

Weekends:

Holidays:No

Call Obligation:No

Union:

Union Posting Deadline:

Compensation Range:

$130,478.40 - $167,273.60

Employee Benefits at Essentia Health*:

Health Coverage: Medical, dental, vision, life and disability insurance, plus supplemental health benefit options to ensure employees' well-being.

Retirement Savings Plans: 401(k) with employer contributions to support long-term financial security.

Professional Development: Opportunities for career growth through training, tuition reimbursement, and educational programs.

Work-Life Balance: Flexible scheduling, time off, holidays, and personal leave to help employees manage their professional and personal lives.

Employee Wellness Programs: Initiatives focused on physical, mental, and emotional health, including fitness memberships, counseling services, and wellness activities.

*Eligibility for Essentia Health’s benefit programs vary. Please refer to the benefit summary provided to you, or contact our HR Service Center at (218) 576-0000 for more information.