A managed care pharmacist is a pharmacist who works within a managed care program to provide patients with effective and efficient services. Care providers in these programs work together to ensure that there is a high level of communication between them. This may make it easier for them to collaborate on patient care and achieve the best possible results. Direct interactions with patients, as well as care providers and insurance companies, may be required.
A managed care pharmacist can conduct utility reviews on various medications and treatment protocols as a representative of a managed care organization. These audits can be used to develop policies and handle claims. If a medication claim does not appear to be justified, it may be denied under the policy. Customers can request an audit to see if the denial was justified, which may be overseen the managed care pharmacist. The pharmacist may consider available alternatives and their efficacy when evaluating a claim.
This can also include looking over new medications and making changes to how they’re used. To ensure that clients are well served, a managed care pharmacist must keep up with industry trends. When setting policy, negotiating with drug companies for bulk pricing, and engaging in other activities, pharmacists affiliated with the organization may interact with the managed care pharmacist. Creating consistent and effective policies can also include things like developing a protocol for advising patients on new prescriptions, detecting drug interactions, and keeping track of patient files.
Care providers may collaborate with the managed care pharmacist and other skilled medical professionals to develop a treatment plan in a complex medical case. They can take into account the managed care company’s policies and procedures, as well as the patient’s specific needs. Companies want to operate efficiently, so financial matters can be a concern, but the needs of the patient can sometimes outweigh these. Because these treatments would provide the most benefits, a care plan may include complex or expensive treatments. Managed care pharmacists assist in determining which treatments should be offered and how they should be delivered.
Maintaining a license to practice and remaining competitive in the industry may necessitate continuing education. Attending conferences and courses, as well as subscribing to trade medications, are examples of this. Some managed care pharmacists work to improve patient outcomes and managed care services through research and publication. They can also work in clinical settings to keep skills sharp, audit member pharmacies, and put proposed policies to the test before they go into effect.