The Clinical Pharmacist with Healthcare Highways will be responsible for developing and maintaining pharmacy related population health management programs. The position will also oversee pharmacy data and information to provide consultative recommendations to clients. The Clinical Pharmacist will also develop and maintain evidence based prior authorization criteria and utilize this information to review and render coverage determinations. This role will also assist with the management and operations of clinical products.
Roles & Responsibilities
- Develop pharmacy related popuation helath programs.
- Develop and update clinical criteria for coverage determinations for participating PBMs.
- Collaborate with Pharmacy Benefit Managers (PBMs).
- Collaborate with Care Coordination / Care Management teams on medication adherence programs.
- Review member appeals.
- Assist with the management and operations of clinical products.
- Understand the plan design parameters available and elected by our clients.
- Analyze pharmacy data to provide recommendations to the clinical team and clients.
- Assist with preparation and delivery of timely and accurate performance reviews.
- Act as an effective liason between clients, brokers, consultants, internal partners, and health plan care management teams.
- Monitor and review pharmacy claims processing as necessary for clients.
- Monitors operational processes and assists in problem solving strategies.
- Train new staff members, provide ongoing training for staff on new processes, and mentor junior colleagues
- Ability to maintain confidentiality and adhere to HIPAA requirements
- Other duties or special projects may be assigned as necessary
Location & Travel:
Up to 20% travel may be required
Qualifications and Education Requirements
The ideal candidate will have a Doctor of Pharmacy degree with 2 or more years of experience space within the PBM industry. The following qualifications are required:
- Excellent verbal, written, interpersonal, and presentation skills, including the ability to tailor the message to the specific audience.
- Active, unrestricted Pharmacist license
- Experience using online clinical references and accessing (clinical and regulatory) websites
- Computer and typing proficiency is required, including MS Office applications (Word, Excel, PowerPoint and Outlook)
- Strong analytical and critical thinking skills
- Collaborative and accountable team player with a positive attitude
- Self-motivated with the ability to work independently with limited supervision
- Strong organization skills with the ability to prioritize in a dynamic environment
- 2 or more years practicing pharmacy experience is preferred
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk and hear and to use hands to finger, handle, or feel. The employee frequently is required to sit. The employee is occasionally required to stand and walk. The employee must occasionally lift and/or move up to 10 pounds.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
A qualified candidate will be a self-starter who has strong attention to detail. Time management and follow through are an important asset in this position. The individual’s ability to communicate and work in a team environment will be essential to succeed in this position.
We're the new competitor in health care working with employers of large, small, and hourly workforces to get the most value out of their health plans and the best health outcomes for all members.
We believe in being transparent about costs, coverage, care and our relationships.
We believe independent healthcare providers should influence where and how patients are treated.
We believe ensuring quality care is our non-compromising obligation, and that health outcomes are its only means of measure.
We view competition as the catalyst with which to bring about the innovation industry needs to drive down costs and drive up quality care.
We believe we are bringing that competition.