Question for Managed Care Pharmacists

[VP_Pharm2004]

Hi everyone,

Just a few general questions for you guys working at an insurance company.

How's the daily workload and what are the daily responsibilities?
Are pharmacists expected to do everything like PA reviews, establish P&T criteria and technician guidelines, work on patient adherence projects, and transitions of care?
Or are pharmacists divided into group with differing roles and responsibilities?
How stressful is the job and would you ever leave the job?
Any insurance plans better than other or are they all the same?
Do you work from home or get to work from home?

Thank you!

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[Jackanese]

1. Daily workload depends on your function. Basically verify prescriptions, review PA, consult with patients, take in phone Rx, etc.

2. It depends. If you work at a large PBM, everyone will have specified roles. If you work at a small one, you'll probably have the opportunity to do a few things.

3. These PBM production based jobs are all numbers based. Leadership always wants to see more. It can be stressful if you're struggling to meet metrics and chasing numbers.

4. At least half the people I work with work at home.

 

[PAtoPharm]

1. Daily workload depends on your function. Basically verify prescriptions, review PA, consult with patients, take in phone Rx, etc.

2. It depends. If you work at a large PBM, everyone will have specified roles. If you work at a small one, you'll probably have the opportunity to do a few things.

3. These PBM production based jobs are all numbers based. Leadership always wants to see more. It can be stressful if you're struggling to meet metrics and chasing numbers.

4. At least half the people I work with work at home.

Do you know of any insurance companies/PBMs that hire pharmacists for work-at-home positions? I've searched and searched the jobs/careers webpages on the websites of all the major insurance companies and PBMs, but I haven't come across a single position posted by any companies in GA.

 

[JustAnotherRph]

How's the daily workload and what are the daily responsibilities?

Daily workload varies based on position. There is so much more out there than just data entry or PA reviewer. It really just depends on what your title is.


Are pharmacists expected to do everything like PA reviews, establish P&T criteria and technician guidelines, work on patient adherence projects, and transitions of care?

This is based on your role. I don't do PA reviews, but I have helped develop PA guidelines, P & T, P & P's, audits, etc.

How stressful is the job and would you ever leave the job?

It's stressful, as with any job, but I won't leave managed care.


Any insurance plans better than other or are they all the same?

They are all the same and pretty much merging left and right.

Do you work from home or get to work from home?

Yes I work from home but also need to make an appearance in the office a few times a month. You generally have to be with the company awhile before this is even considered or be hired for a position that is higher up than entry level.

 

[MIRPh]

How's the daily workload and what are the daily responsibilities?

Daily workload varies based on position. There is so much more out there than just data entry or PA reviewer. It really just depends on what your title is.


Are pharmacists expected to do everything like PA reviews, establish P&T criteria and technician guidelines, work on patient adherence projects, and transitions of care?

This is based on your role. I don't do PA reviews, but I have helped develop PA guidelines, P & T, P & P's, audits, etc.

How stressful is the job and would you ever leave the job?

It's stressful, as with any job, but I won't leave managed care.


Any insurance plans better than other or are they all the same?

They are all the same and pretty much merging left and right.

Do you work from home or get to work from home?

Yes I work from home but also need to make an appearance in the office a few times a month. You generally have to be with the company awhile before this is even considered or be hired for a position that is higher up than entry level.

As a RPh(BS Pharm) with retail background, what chances might I have in finding a managed care job? I have no relevant experience in that setting ,nor do I have a residency....
I'm willing to start low and work up to gain experience, but what positions should I apply for ?
Any advice would be helpful.
Thanks

 

[JustAnotherRph]

I think anyone can find a job in managed care starting as a prior authorization pharmacist or even data entry/order verification. That is how I started and started asking for more projects and reaching out more to gain more skills.