Clinical Pharmacist - Formulary Authorization

Department of Veterans Affairs

Clinical Pharmacist reviews medication requests that require prior authorization, ensuring they meet formulary, safety, and clinical criteria. They evaluate restricted or high-cost drug requests, verify guideline compliance through chart review, identify safer or more cost-effective alternatives, and work directly with providers to approve, deny, or recommend appropriate options.

• Conducts critical review of all Prior Authorization Drug Requests (PADRs) for the medical center. Monitors daily PADR volume and timing, coordinating with supervisors to ensure timely adjudication. Manages all appeal and brand-only requests and tracks each case through completion. Reviews PADR reports and ensures quarterly data corrections are completed. Applies the organization's formulary, guidelines, and restrictions to all PADRs under review. Develops criteria for use when none exist, based on Pharmacy Benefits Management monographs, formulary guidance, and drug information. Reviews and applies criteria for use for each requested medication or supply. Analyzes and incorporates relevant published medical literature into PADR adjudication. Collaborates with procurement technicians to ensure optimal resource use and communicate changes in drug availability. Strives to deliver optimal drug therapy while balancing medication or supply availability and cost. Documents PADR adjudications and formulary-related activities in the electronic health record in a timely, professional manner. Communicates with providers, pharmacists, and staff throughout the adjudication process to provide input and feedback as needed. Coordinates with relevant stakeholders when reviewing, commenting on, and adjudicating PADRs. Serves as a resource for clinical pharmacists and providers regarding formulary status and requirements for restricted or non-formulary medications. Participates in discussions on formulary, restricted, and non-formulary use to support evidence-based, cost-effective therapy. Promotes compliance with the medical center's formulary and drug utilization guidelines. Supports adjudication and procurement processes for specialty-medication PADRs. Provides assistance with Risk Evaluation and Mitigation Strategy (REMS) program requirements. Supports activities related to the investigational drug program. Applies LEAN principles to improve workflow and infrastructure, including developing quick orders and menus. Participates in onboarding new informatics tools and programs as needed across the facility. Participate in training and in-servicing for medical staff, nursing staff, residents, students, and other allied health professionals. Instruct patients and family members on proper use of medications and medical devices. Serve as a preceptor for pharmacy students and residents as needed. Assist with new employee orientation. Help develop proposals for improved or new clinical pharmacy services. Participate in and attend staff development presentations for pharmacy personnel. Maintain a clinical faculty appointment at the University of New Mexico College of Pharmacy. Evaluate prescribers' medication orders for appropriateness and verify/finish pending inpatient orders. Enter or finish outpatient prescriptions for dispensing. Work Schedule: Monday to Friday, 8:00AM - 4:30PM Telework: Not Available Virtual: This is not a virtual position. Functional Statement #: 000000 Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized

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