How to Be Managed Care Pharmacist - Job Description, Skills, and Interview Questions

Managed care pharmacists play a vital role in ensuring the delivery of high-quality and cost-effective healthcare. By closely monitoring prescription drug use and costs, they can help reduce the total cost of care and improve patient outcomes. they can identify potential adverse drug interactions and provide guidance on best practices for appropriate drug therapies.

This helps to reduce the risks associated with medications and ensure patients receive safe, effective, and cost-efficient treatments. the managed care pharmacist's role in healthcare is invaluable, as they help to improve outcomes while keeping costs under control.

Steps How to Become

1. Earn a Bachelor of Science in Pharmacy. Most managed care pharmacists must first earn a bachelor’s degree in pharmacy from an accredited college or university. Courses may include pharmacology, biology, chemistry, anatomy, and physiology.
2. Gain Experience. Many managed care pharmacies require at least two years of experience in retail pharmacy, hospital pharmacy, or other pharmaceutical setting.
3. Obtain a State License. All pharmacists must be licensed in the state in which they practice. Licensure requirements vary by state, but generally include passing the North American Pharmacist Licensure Exam (NAPLEX).
4. Pursue Additional Certifications. Managed care pharmacists may choose to pursue additional certifications to demonstrate their expertise and commitment to the field. The American Society of Health-System Pharmacists offers specialty certification in managed care pharmacy.
5. Stay Current on New Developments. Managed care pharmacists must stay up-to-date on new developments in the field, such as new medications, treatments, and regulations. They should also be familiar with the latest advances in technology and computer systems used in the industry.

Managed care pharmacists must stay up to date and competent in order to ensure that patients receive the best possible care. To do this, they must stay informed of the latest developments in pharmaceuticals, health care legislation, and industry regulations. They must also understand the various managed care plans and how they affect patient care.

they must be aware of current trends in their field, such as specialty medications and medication management systems. To keep their skills and knowledge current, managed care pharmacists should take continuing education courses, participate in professional organizations, and attend conferences. Keeping up with the changes in their field will help them to provide the best possible care to their patients.

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Job Description

1. Develop, implement, and monitor medication therapy management (MTM) programs.
2. Review and assess patient medication histories and provide clinical drug therapy advice to patients and other healthcare providers.
3. Create, evaluate, and update formularies to ensure that medications meet established standards of safety, efficacy, and cost-effectiveness.
4. Develop and implement quality assurance initiatives to ensure safe and effective medication use.
5. Act as a consultant to healthcare providers, providing information on drug therapies, drug interactions, and side effects.
6. Monitor the effectiveness of drug therapies and recommend changes when needed.
7. Develop and manage drug utilization review (DUR) programs to reduce prescribing errors and improve the quality of patient care.
8. Educate patients on the proper use of medications, including dosage instructions and potential side effects.
9. Coordinate patient care with other healthcare providers, such as physicians, nurses, and pharmacists.
10. Monitor quality control measures to ensure compliance with applicable regulations.

Skills and Competencies to Have

1. Knowledge and understanding of managed care pharmacy principles and practice.
2. Knowledge and understanding of drug formularies, utilization management, and prior authorization processes.
3. Proficiency in the use of technology related to managed care pharmacy systems and software.
4. Ability to interpret, analyze, and evaluate medical data to facilitate appropriate medication use and formulary decision-making.
5. Knowledge and understanding of reimbursement criteria and clinical drug information.
6. Ability to communicate effectively with healthcare professionals, patients, employers, and managed care organizations.
7. Knowledge and understanding of applicable laws, regulations, and policies related to managed care pharmacy.
8. Ability to develop, implement, and maintain quality assurance programs for managed care pharmacy services.
9. Ability to assess benefit design and provider contracting strategies.
10. Ability to develop and implement programs for effective drug utilization management.
11. Ability to identify appropriate clinical indicators for data analysis and trend reporting.
12. Knowledge and understanding of pharmacy benefit management (PBM) operations and services.
13. Knowledge of drug coverage policies and procedures.
14. Knowledge of medication therapy management (MTM) techniques, services, and programs.
15. Knowledge of health plan operations and accreditation standards.

The role of a Managed Care Pharmacist is crucial in the healthcare system. It is essential for them to have a wide range of skills to be successful. The most important skill for a Managed Care Pharmacist is the ability to analyze and interpret data.

This includes having a strong understanding of the pharmaceutical industry, health care regulations, and reimbursement policies. By being able to understand the data, they can help identify potential savings and develop strategies to reduce costs. Furthermore, the pharmacist must have excellent communication and collaboration skills to interact with healthcare professionals, patients, and insurers.

With these skills, they can ensure that the best possible care is provided while adhering to all regulations and laws. In addition, Managed Care Pharmacists must be able to efficiently manage their time and resources to ensure that all tasks are completed in a timely manner. All of these skills are essential for a Managed Care Pharmacist to be successful in their role.

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Frequent Interview Questions

• What experience do you have with managed care pharmacy?
• How do you ensure accuracy when dealing with formularies and other managed care requirements?
• Describe a situation in which you had to resolve a conflict between patient needs, physician requests, and managed care requirements.
• What strategies do you use to ensure compliance with managed care contracts?
• How do you stay up-to-date on changes in the managed care industry?
• Describe your experience with interacting with government and private payers.
• How do you optimize the utilization of drug therapies while ensuring patient safety?
• What techniques do you use to ensure adherence to medications?
• How do you communicate complex managed care information to patients and providers?
• Describe a time when you successfully negotiated a managed care contract for a pharmacy.

Common Tools in Industry

1. Electronic Health Records (EHR). A digital record of patient health information, including medical history, medications, test results, and more. (eg: Epic EHR)
2. Automated Dispensing Systems. Systems that can dispense medications and track usage in a pharmacy. (eg: Pyxis Automated Dispensing System)
3. Clinical Decision Support System (CDSS). Software that helps healthcare professionals provide evidence-based care and make decisions. (eg: UpToDate CDSS)
4. Drug Information Databases. Databases containing drug reference information, including dosages, side effects, and interactions. (eg: Lexicomp Drug Database)
5. Pharmacy Benefit Management (PBM) Software. Software used to manage prescription drug benefit plans for employers and health plans. (eg: Express Scripts PBM Software)
6. Pharmacy Automation Systems. Systems that automate the filling and packaging of prescriptions. (eg: Kuka Robot Pharmacy Automation System)
7. Medication Reconciliation System. Systems that compare a patient's current medications with prior medications to ensure accuracy and reduce errors. (eg: Cerner MedRecon System)
8. Claim Management Software. Software used to manage pharmacy benefit claims processing. (eg: RxClaim Claim Management Software)

Professional Organizations to Know

1. Academy of Managed Care Pharmacy (AMCP)
2. American Pharmacists Association (APhA)
3. National Association of Chain Drug Stores (NACDS)
4. American Society of Health-System Pharmacists (ASHP)
5. National Association of Specialty Pharmacy (NASP)
6. National Community Pharmacists Association (NCPA)
7. International Society for Pharmacoeconomics and Outcomes Research (ISPOR)
8. American College of Clinical Pharmacy (ACCP)
9. American Association of Colleges of Pharmacy (AACP)
10. National Pharmaceutical Association (NPA)

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Common Important Terms

1. Managed Care Organizations (MCOs). Organizations that provide health insurance coverage and manage care for members.
2. Pharmacy Benefit Managers (PBMs). Organizations that negotiate with drug manufacturers to obtain discounts on medications and administer prescription drug benefits for MCOs.
3. Formularies. Lists of medications covered by a health insurance plan.
4. Prior Authorization. A process that requires a doctor to get approval from an MCO before prescribing certain medications.
5. Step Therapy. A process in which an MCO requires patients to try lower-cost medications before approving more expensive medications.
6. Drug Utilization Review (DUR). A process in which a pharmacist reviews the appropriateness of medications prescribed by a doctor in order to ensure quality of care and reduce costs.

Frequently Asked Questions

What is a Managed Care Pharmacist?

A Managed Care Pharmacist is a pharmacist who specializes in the delivery of pharmaceutical care services to patients in managed care settings. They work to ensure that patients receive the most cost-effective medication and optimal therapeutic outcomes.

What are the responsibilities of a Managed Care Pharmacist?

The main responsibilities of a Managed Care Pharmacist include evaluating and approving prescription orders, providing drug utilization review and formulary management, assisting with medication therapy management, and providing medication education to patients.

What qualifications are needed to become a Managed Care Pharmacist?

To become a Managed Care Pharmacist, one must have a Doctor of Pharmacy Degree from an accredited college of pharmacy, and must be licensed to practice pharmacy in the state where they plan to work. Additionally, some employers may require additional certifications or experience.

What type of setting do Managed Care Pharmacists typically work in?

Managed Care Pharmacists typically work in managed care organizations, such as health maintenance organizations (HMOs), preferred provider organizations (PPOs), or integrated delivery networks (IDNs).

What is the average salary for a Managed Care Pharmacist?

According to the U.S. Bureau of Labor Statistics, the average annual salary for a Managed Care Pharmacist is $118,913 as of May 2020.

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Web Resources

• Managed Care Pharmacy Systems - University of Florida onlinepop.pharmacy.ufl.edu
• Managed Care Pharmacy Concentration | PCOM School of … www.pcom.edu
• Managed Care Pharmacy (UM PDP) | Pharmacy medicine.umich.edu