A managed care pharmacist coordinates with caregivers to provide efficient services to patients. They review medication and treatment protocols, set policies, and work with medical professionals to develop treatment plans. Continuing education is required to remain competitive.
A managed care pharmacist works within a managed care program to provide effective and efficient services to patients. In these programs, caregivers coordinate to maintain a high degree of communication with each other. This can help them cooperate in patient care to achieve the best possible outcome. The job may involve direct interactions with patients, caregivers and insurance companies.
As a representative of a managed care organization, a managed care pharmacist can perform utility analyzes on different types of medications and treatment protocols. These reviews can be used to define policies and process claims. If a drug request does not appear justified, it may be denied in accordance with policy. Customers may request an audit, which may be overseen by the managed care pharmacist, to determine whether the denial was fair. In this evaluation of a claim, the pharmacist may consider available alternatives and their effectiveness.
This can also include reviewing new drugs and changes to the way drugs are used. A managed care pharmacist needs to keep up with industry trends to ensure customers are served well. Pharmacies belonging to the organization may interact with the managed care pharmacist when setting policies, negotiating with pharmaceutical companies for bulk pricing, and engaging in other activities. Creating consistent and effective policies can also extend to activities such as creating a protocol for advising patients on new prescriptions, capturing drug interactions, and managing patient files.
In a complex medical case, care providers may work with the managed care pharmacist and other qualified medical professionals to develop a treatment plan. They can consider policies and procedures at the managed care company, along with the patient’s best needs. Financial matters can be a concern as these companies want to operate efficiently, but sometimes the patient’s needs outweigh them. A care plan can involve complex or expensive treatments because they offer more benefits. Managed care pharmacists help decide which treatments should be offered and how.
Continuing education may be required to maintain a license to practice and remain competitive in the industry. This can include attending conferences and courses, as well as subscribing to commercial drugs. Some managed care pharmacists are actively involved in research and publication to improve patient outcomes and managed care services. They may also work in clinical settings to retain skills, audit member pharmacies, and test proposed policies in the field before implementing them.
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