Clinical Pharmacist- Prior Authorization Drug Request Adjudication

Major Duties: A. Prior Authorization Drug Request (PADR) Reviews: 1.

Critically reviews all PADRs, facility wide (internal and CCN), for appropriateness. a) Implements and applies the VA formulary, guidelines, and restrictions to all PADRs being adjudicated. b) Understands, reviews, and applies criteria for use for each requested drug as appropriate. c) Reviews, analyzes, and applies the available medical literature as it pertains to PADRs and their adjudication. 2.

Seeks to provide patients with the best drug therapy possible while balancing drug availability and cost. 3. Interfaces and communicates with providers, pharmacists, procurement and other staff, as needed, providing input and feedback before, during, and after the adjudication process for requested drugs. 4.

Coordinates with clinical pharmacists when reviewing, commenting on, and adjudicating CCN PADRs (entered by clinical pharmacists). 5. Acts as a reference to pharmacists and providers in answering questions about the formulary status and requirements for obtaining nonformulary or restricted drugs. 6.

Actively participates in formulary, restricted, and non-formulary usage discussions to promote evidence-based, cost-effective drug therapy. 7. Promotes compliance with the VHA National Formulary and clinical guidelines in the Health System. 8.

Provides consistent oversight of prior authorization reviews allowing for equal care amongst patients seen at the facility as well as via community care. 9. Assists in conducting and reporting internal audits as required. Maintains all pertinent professional and administrative records as necessary.

Assists in data collection for drug utilization evaluations and adverse drug events. 10. Acts as a liaison between Pharmacy Service and other health care providers. 11. Performs other duties as assigned. Work Schedule: Non-compressed tour (8 hours) between the hours of 6 AM - 6PM; Every other weekend.

Tour may be adjusted to meet medical center and patient care needs Telework: Ad Hoc Virtual: This is not a virtual position. Functional Statement #: 942600 Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized

Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met. Basic Requirements: United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.

Education: (1) Graduate of an Accreditation Council for Pharmacy Education (ACPE) accredited College or School of Pharmacy with a baccalaureate degree in pharmacy (BS Pharmacy) and/or a Doctor of Pharmacy (Pharm.D.) degree.

Verification of approved degree programs may be obtained from the Accreditation Council for Pharmacy Education, 20 North Clark Street, Suite 2500, Chicago, Illinois 60602-5109; phone: (312) 664-3575, or through their Web site at: http://www.acpe-accredit.org/.

(NOTE: Prior to 2005 ACPE accredited both baccalaureate and Doctor of Pharmacy terminal degree program.

Today the sole degree is Doctor of Pharmacy.) (2) Graduates of foreign pharmacy degree programs meet the educational requirement if the graduate is able to provide proof of achieving the Foreign Pharmacy Graduate Examination Commission (FPGEC) Certification, which includes passing the Foreign Pharmacy Graduate Equivalency Examination (FPGEE) and the Test of English as a Foreign Language Internet- Based Test (TOEFL iBT).

Licensure. Full, current and unrestricted license to practice pharmacy in a State, Territory, Commonwealth of the United States (i.e., Puerto Rico), or the District of Columbia. The pharmacist must maintain current registration if this is a requirement for maintaining full, current, and unrestricted licensure.

A pharmacist who has, or has ever had, any license(s) revoked, suspended, denied, restricted, limited, or issued/placed in a probationary status may be appointed only in accordance with the provisions in VA Handbook 5005, Part II, Chapter 3, section B, paragraph 16. English Language Proficiency.

Pharmacists must be proficient in spoken and written English as required by 38 U.S.C. 7402(d), and 7407(d). May qualify based on being covered by the Grandfathering Provision as described in the VA Qualification Standard for this occupation (only applicable to current VHA employees who are in this occupation and meet the criteria).

Grade Determinations :In addition to the basic requirements for employment listed above, the following criteria must be met when determining the grade of candidates. GS-12 Clinical Pharmacist (Full Performance Level) Experience or Education.

In addition to the basic requirements, candidates must meet one of the following: 1. 1 year of experience equivalent to the next lower grade level, or 2. Completion of an ACPE-accredited Pharm.D. program. AND Demonstrated Knowledge, Skills, and Abilities - Candidates must demonstrate the KSA's listed below: 1.

Knowledge of professional pharmacy practice. 2. Ability to communicate orally and in writing to both patients and health care staff. 3. Knowledge of laws, regulations, and accreditation standards related to the distribution and control of scheduled and non-scheduled drugs and pharmacy security. 4.

Skill in monitoring and assessing the outcome of drug therapies, including physical assessment and interpretation of laboratory and other diagnostic parameters. Assignment.

A pharmacist in this assignment handles routine medication-related activities in accordance with local, Veterans Integrated Service Network (VISN), and national policies and regulations.

These include, but are not limited to: reviewing, interpreting, and verifying medication orders for appropriateness; processing and filling medication orders; interacting with and making recommendations to other clinical staff regarding medication therapy ordered to ensure safe and effective care; reviewing the patient's medications, allergies, labs, and other pertinent information from the medical record to identify and solve medication-related problems; contacting providers as appropriate; documenting recommendations and interventions; providing refill extensions and partial medication supplies; taking health and medication histories; performing medication reconciliation; providing drug information; assisting in formulary management including therapeutic substitutions, nonformulary reviews and medication usage evaluations; documenting and assessing adverse drug events (ADEs); assisting in medical emergencies; providing oversight of technical staff in all aspects of medication distribution.

Preferred Experience: in non-formulary adjudication Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/. The full performance level of this vacancy is GS-12. The actual grade at which an applicant may be selected for this vacancy is at the GS-12 level.

Physical Requirements: The work environment is an inpatient pharmacy, an outpatient pharmacy or a patient care area environment (including the Surgical Suite or Emergency Department). Some home visits may be required in the home based primary care role.

There may be extremes of temperature, distractions, noise from equipment or patient care activities. Deals with frozen and refrigerated products often. May be required to use heating equipment. Exposure to negative and positive air pressure rooms is also possible.

Must be able to don and work with protective garments and equipment as necessary for assignment. May work with cleaning and disinfecting products occasionally. Must have the use of fingers; both hands required; Twisting and grasping of bottles and vials or syringes occurs frequently.

Some lifting (50 lbs.), stretching and forward and overhead reaching is involved. Walking and standing 8-12 hours; repeated bending 8 hours; both legs required. May have to kneel in order to retrieve product from lower cabinets or the floor. Must be able to rapidly coordinate mental and muscular duties simultaneously.

Computer keyboard activity and computer monitor use isfrequently performed. May be required to operate robotic packaging machinery and automated dispensing devices. Fine motor skills (for packaging and counting) and excellent visual acuity (for expiration date and tablet identification and prescription interpretation)are required.

Near vision correctable @ 13" to 16" to Jaeger 1 to 4; far vision correctable in one eye to 20/20 and to 20/40 in the other; depth perception; ability to distinguish shades of colors. Hearing acuity is required for phone communication, patient counseling and professional communication. (hearing aid use is permitted).

The incumbent may be exposed to infected patients and contaminated materials. The incumbent may occasionally be exposed to patients whoare combative secondary to delirium, dementia, or psychiatric disorders.

The incumbent must be a mature, flexible, sensible individual capable ofworking effectively in stressful situations and able to shift priorities based on patient needs. Works closely with others. May have protracted orirregular hours of work. Shift rotation is commonly required.