Health Net, Inc. (NYSE: HNT) is among the nation's largest publicly traded managed health care companies. Health Net's mission is to help people be healthy, secure and comfortable. The company's POS, HMO, insured PPO, behavioral health and government contracts subsidiaries provide health benefits to more than 7 million individuals. For more information on Health Net, Inc., please visit the company's Web site at www.healthnet.com



JOB SUMMARY:

The Clinical Pharmacist - Medicare Part D provides specialized support for Medicare lines of business as it applies to clinical pharmacy operations for Medicare Part D. This position reviews Medicare Part D formularies and makes clinical recommendations with respect to utilization management restrictions and to ensure formularies meet the therapeutic requirements mandated by CMS.





ESSENTIAL DUTIES AND RESPONSIBILITIES:

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Provides clinical and operational support for planning, creating, maintaining and reviewing Health Net Medicare Part D Formularies, Prior Authorization (PA) criteria, Step Therapy (ST) Criteria and other utilization management (UM) restrictions.
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Ensures timely and accurate submission of all HPMS formulary files, PA files, ST files and other UM restrictions in accordance with CMS requirements.
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Creates, maintains, reviews and approves ST files/documents for submission to HPMS.
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Responsible for maintaining files to support monthly updates of formulary print and website documents including Health Net Medicare Part D formularies, PA criteria, ST criteria and Negative Formulary Changes.
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Oversees Transition Program to ensure clinical and operational functionality is implemented to support an appropriate transition process for new enrollees prescribed Part D drugs that are not on the formulary.
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Oversees Negative Formulary Change Process to ensure required notification and revisions of formulary documents and systems are complete.
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Performs quality assurances on and maintains Health Net's Medicare Part D formularies in the Formulary and Benefit (FAB) system.
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Acts as clinical liaison between HNPS and the pharmacy claims processor.
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Participates in the development and maintenance of new programs required by CMS.
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Ensures HNPS' compliance with CMS formulary requirements per the Medicare Prescription Drug Benefit Manual, Chapter 6 - Part D Drugs and Formulary Requirements
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Create/revise policies and procedures pertaining to Health Net's Medicare Part D program.
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Provides guidance and clarification for Part B v. Part D coverage determinations.
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Provides timely and accurate responses to regional and departmental inquiries/requests regarding Medicare Part D formulary issues.


Qualifications


REQUIREMENTS:



Education:

Bachelor's or Doctorate of Pharmacy degree



Certification/License:

Current Pharmacist license in the state of employment and credentialed by the health plan of employment



Experience:

Two to four years experience working within a pharmacy or related health care environment

Minimum one year pharmacy residency training completed (or equivalent training/experience) preferred



Knowledge, Skills & Abilities:

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Expert pharmaceutical clinical knowledge
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Ability to collect, analyze and present data
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Ability to conduct business studies and recommend solutions
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Strong analytical and problem solving skills
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Knowledge of functional area policies, procedures, processes, and standards
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Excellent writing skills for preparing narrative reports and correspondence
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Knowledge and ability to apply advanced features of PC based programs and database management systems
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Demonstrated ability to prioritize and manage multiple responsibilities and deadlines



OR
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.



Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.