PBM Jobs--What is the deal?

[clarkbar]

I have come across PBM job adverts from time-to-time; usually prior authorizations or liazon jobs, where you cater to local company's HR benefits department, help with the formulary, etc. They don't seem to require much clinical background. (Which ones do?)


What are these jobs like? I have read that the prior auth jobs are like CVS, only with call centers. Is this true? What other jobs for pharmacists are at these places? Thanks you.

Here is an advert for a prior auth rph I recently came across:

Responsibilities​

• Review non-formulary drug requests using predetermined criteria.
• Review prior authorization requests using predetermined criteria and other medication resources.
• Maintain current knowledge of drug therapies and drug reactions and interactions by reading professional literature, attending seminars and through professional affiliations.
• Provides drug information to meet the needs of medical and nursing staff members through direct contact or in-service programs.
• Prepare drug reviews, agendas, and other required materials for Pharmacy & Therapeutic (P&T) Committee meetings as assigned.
• Contact and confer with pharmacists and physicians regarding questions or irregularities on prescriptions.
• Attend and participate in other programs, committees, meetings, and functions as required.
• Perform retrospective drug utilization review: identify drug, physician and patient utilization trends; make interventions as appropriate via letters, phone calls, meetings, educational programs, mail order intervention programs; monitor and document outcomes as needed.
• Work with Lead PA Pharmacist to identify operational efficiencies within the PA department.
• Assist in the review of new drugs entering market and potential implication of drug costs and report the findings to management.
• Work cooperatively with other staff members to enhance the team concept.
• Assist with creating operating efficiencies for Clinical Associates.
• Maintain regular attendance in accordance with established policies.
• Perform other job-related duties as assigned.
• Promptly report any allegations of impropriety to the Compliance Department.
• Comply with Maxor’s Ethical Business Conduct policy and Maxor’s Compliance Program.
• Remain free from exclusion under the OIG and SAMS Medicare/Medicaid lists.
• Complete required training as required.

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[clarkbar]

bump

 

[sunnyandseventytwo]

There are only retail and hospital pharmacists on this forum.

Not sure what you're asking. It's a job. It can be done entirely remotely. There are dozens of different pharmacist jobs at PBMs, but prior auth is usually the only way you can get into a PBM with only retail experience. Prior Auth jobs are metric heavy--you will be reviewed based on how quickly/accurately you approve/deny requests. A respectable PBM will not review you based on your approval/denial rate, but they'll know this metric as well. You probably won't have to talk to patients, but you'll most likely have to deal with angry physicians. Most prior auth requests are not received by phone, so talking to angry doctors will not be a huge part of your job.

Note: the majority of prior auth hiring occurs in the end of 3rd quarter/beginning of 4th quarter each year. They need you ready for January when everyone changes plans and needs new prior auths. I'm sure it's company specific, but many PBMS hire tons of temporary pharmacists and then get rid of them all by March. If you start with 50 new coworkers, maybe 3 of them will be offered permanent jobs.

 

[clarkbar]

That's definitely good info. I have seen these prior auth jobs being overwhelmingly what's offered as well.
Are there other PBM jobs to watch out for, for rphs with extensive inpatient or outpatient clinical experience, or other non-prior auth jobs in general? I prefer stability and/or career track options. Thank you.

 

[projektreverb]

Usually you’ll start your career in pbms as an mtm or PA pharmacist. From there you can build up. If you follow my journey, I started as remote mtm pharmacist in a contract role. I eventually got converted, along with about half the contractors that started with me.

I eventually moved on to a PA pharmacist role, also remote. The hardest part is getting in. From here I’m looking to either build up into a different role or possibly jump to pharma. The issue I’m running into with pharma is those roles aren’t remote, which I realize is a self imposed barrier.

Both roles are very metrics driven, but usually you’re in charge. They do keep track of computer activity in most roles, and any calls you place are usually evaluated. If you’re ok with your work being heavily scrutinized, then you’ll be fine in these roles.