The PBM Pharmacist provides clinical support to OHSU Pharmacy Benefit Management Services. Support
includes but is not limited to formulary management, coverage determinations, Pharmacy and Therapeutics
Committee support, responding to clinical inquiries, and implementing clinical programs.
Formulary management including but not limited to activities such as adjudication, formulary decision making, and benefit determination.
Respond to and resolve clinical inquiries from members, clients, providers, or pharmacies related to formulary options, therapeutic alternatives, and coverage determinations.
Oversee completion of prior authorization requests for members through collaboration with PBM Pharmacy Technicians.
Coordinate with pharmacy claims processor to ensure formularies, clinical edits, and plan designs are implemented according to requirements.
Utilize claims data to evaluate benefit design for inappropriate utilization and opportunities to improve outcomes and optimize drug spend.
Job Related Knowledge, Skills and Abilities (Competencies):
The PBM pharmacist will experience competing demands and frequent interruptions from PBM Technicians, clients, members, and other health care professionals.
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