West Virginia University·West Virginia
Conduct clinical reviews of prior authorization requests and perform drug utilization reviews for Medicaid, PEIA, and CHIP members. Provide professional pharmacy services and recommendations for formulary alternatives to ensure safe and cost-effective drug therapy.
The Department of Pharmaceutical Systems and Policy in the School of Pharmacy at West Virginia University is currently accepting applications for a Pharmacist at the Rational Drug Therapy Program.
About the Opportunity As a Pharmacist at Rational Drug Therapy Program, you will be responsible for conducting clinical reviews of prior authorization requests, performing concurrent drug utilization review with program instructions, and providing general pharmacy information using the point-of-sale computer system established by the West Virginia Bureau of Medical Services (WVBMS) and the current point-of-sale computer system utilized by the PEIA program.
Through this role, you will assist in carrying out Rational Drug Therapy Program’s mission to ensure WV Medicaid, WV PEIA, and CHIP members receive safe, rational, cost effective, and patient outcome-oriented drug therapy.
In this role, you will additionally be performing reviews of prior authorization requests for the Peak Healthcare program in the computer system utilized by that program.
We strongly believe in work-life balance and keeping time for things we love outside our work.
WVU offers generous benefits, including: 37.5-hour work week 13 paid holidays (staff holiday calendar) 24 annual leave (vacation) days per year (employee leave) 18 sick days per year (for when you’re ill, for when you need time to care for sick family, for your own, or your family’s, regularly scheduled medical appointments.
Who is family for the purpose of this leave?
A lot of people in your life including immediate relatives and in-laws as well as others considered to be members of your household living under the same roof WVU offers a range of health insurance and other benefits 401(a) retirement savings with 6%25 employee contribution match, eligibility to continue health insurance, and other retiree perks.
Looking for more retirement benefits information?
Check out retirement health insurance benefits, retirement income, and FAQ’s Wellness programs What You'll Do Provide professional services to the WVBMS which include but are not limited to: Prior authorization clinical review.
Evaluations of appropriateness of therapeutic duplication.
Recommendations of appropriate formulary alternative.
Conduct reviews of home infusion therapy request.
Literature reviews applicable to prior authorization request.
Clinically evaluate the appropriateness of various infectious disease drug therapy regimens.
Evaluate the clinical appropriateness of drug therapy approval with newly marketed medications as allowed by the program.
Evaluate claims for accuracy of billing.
Review individual prior authorization, drug utilization review, and billing inquiries and use clinical decision-making skills and therapeutic judgment to determine if claim payment can be approved.
Acquire and maintain clinical knowledge and information on various disease states in which the program is involved via current, evidenced-based recommendations.
Review inquiries from technical employees of the program and ascertain the clinical appropriateness of the outcome in comparison to the drug utilization evaluation against which the inquiry is being presented.
Respond to inquiries in a friendly, professional manner.
Assist in the orientation and training of all new professional and non-professional personnel.
Weekend staffing of the program on a rotating basis (approximately every 7-10 weeks depending on staffing needs).
Bachelor’s degree in Pharmacy or Doctor of Pharmacy Degree A minimum of one (1) year of experience in the following: Retail or hospital pharmacy experience All qualifications must be met by the time of employment.
Demonstrated ability to make valid clinical judgments concerning a patient's drug therapy needs, given the guidelines of the program. Demonstrated excellent verbal and written communication skills. Demonstrated ability to work as a team player and make constructive suggestions to appropriate peers and supervisors. Exhibits excellent customer service skills and orientation. Exhibits excellent skills in handling difficult persons. Demonstrates knowledge of appropriate drug use in most common disease states. Exhibits a strong understanding of retail pharmacy operations and insurance billing processes associated with retail pharmacy operations. Demonstrated excellent computer data entry, software (Windows based), and typing skills. Ability to follow guidelines and convey information in an accurate manner. Exhibits the flexibility and the ability to work with different insurance plans and different guidelines. Demonstrates the ability to perform duties in compliance with WVU HIPAA and patient confidentiality requirements. Ability to maintain proper unit attendance and punctuality standards.
Requires a Bachelor's or Doctor of Pharmacy degree and at least one year of retail or hospital pharmacy experience. Candidates must demonstrate strong clinical judgment, communication skills, and knowledge of insurance billing processes.
Market context
Pharmacy roles in West Virginia are typically driven by steady healthcare demand in hospitals, clinics, and community settings, with employers looking for candidates who can work accurately and communicate clearly with patients and care teams. These positions can be competitive because they require an M.D. or D.O., board certification or eligibility within five years of residency, and West Virginia licensure or eligibility. Review the AI-summarized requirements and benefits here to save time, then confirm your licensure status and prepare examples of patient-facing communication and basic computer use.