• Perform prospective and retrospective coverage reviews and appeals per State and Federal regulations. • Serve as a clinical resource to aid in solving basic to mid-level reviews with limited assistance and supervision. • Maintain denial rationale associated with clinical criteria and ensure that decision letters meet regulatory compliance and guidance. • Participate in alternating team on-call rotation.

• Complete remote order entry, order verification, and drug verification • Provide patient counseling when needed • Navigate multiple pharmacy information systems (PIS) • Provide drug information and therapeutic guidance to providers • Assess medication appropriateness, dosing (including renal/hepatic adjustments), interactions, and compatibilities • Support specialized populations such as pediatrics, geriatrics, pregnant/nursing patients, HIV, and those with renal/hepatic impairment • Maintain knowledge of IV therapies, TPN, cardiac/narcotic drips, IV antibiotics, chemotherapy, and more • Document interventions and clinical actions accurately and promptly • Communicate effectively with physicians, nurses, and patients • Ensure compliance with HIPAA, pharmacy laws, and client policies • Work across VPNs, automation systems, and multiple PIS platforms • Use applications such as Google Suite/Microsoft Office and Snagit • Maintain required licenses, credentials, and system access • Participate in ongoing training (clinical, PIS, and policy updates) • Meet productivity and quality standards

• Consult directly with patients, their caregivers, and other members of their care team to implement Evergreen’s comprehensive pharmacy care management programs, including medication reconciliation, patient education, and collaboration with the patient’s care team to resolve medication concerns. • Utilize principles of Comprehensive Medication Management (CMM) to optimize all clinical aspects of medication therapy regimens, considering effectiveness of medications, identify unnecessary drug therapies, incomplete immunization records, medication safety, adverse effects, renal dose adjustments, and other contraindications. • Engage in patient outreach and consultation to support real-world adherence with the medication plan of care, integrating best practice techniques for behavior modification, to optimize patient health outcomes. • Drive medication-related clinical quality initiatives, including GDMT optimization and adherence improvement, by identifying gaps, designing targeted interventions, and partnering with care teams to improve patient outcomes and performance against value-based quality measures. • Participate in medication safety initiatives to minimize use of nephrotoxic medications among our CKD patient population and address other high-risk medication use with a holistic, patient-centered approach. • Support appropriate medication use across the continuum of care, focusing on the post-hospital discharge period, to ensure patients accurately implement the medication plan. • Seek alternatives as necessary to ensure the best care is provided that will maximize clinical outcomes, ensure equitable access to medications, and support appropriate levels of financial spend. • Analyze and recommend cost-savings strategies based on plan formularies, insurance phases, and evidence-based chronic disease management guidelines. • Act as an internal subject matter expert, developing and delivering education to patients, caregivers, and internal Evergreen teams regarding medications and chronic disease states. • Other duties consistent with this role, as assigned.

• Provide daily support to the Trillium pharmacy team • Coordinate work with the Pharmacy Benefit Manager (PBM) and the State Department of Health Benefits (DHB) • Assist in performing medication reconciliations under supervision • Support pharmacy team in clinical programs including Medication Reconciliations • Responsible for data analysis and reports • Assist Trillium team members with pharmacy related information/projects • Assist with pharmacy provider network outreach and communication • Handle member inquiries related to formulary/preferred drug list (PDL) process or access issues