Clinical Pharmacist

THIS IS NOT A REMOTE POSITION - Required to work in Wheeling - Hybrid.

Responsible for comprehensive knowledge of current pharmacotherapeutic principles, disease state and population management to help ensure the delivery of safe, appropriate, and cost-efficient pharmaceutical care to membership.

Required

Desired

Responsibilities

• 1.
• Remain continually updated regarding new products, indications, and industry trends.
• 2.
• Develop and present new drug policies for P&T Committee review.
• 3.
• Collaborate with The Health Plan physicians, pharmacists, nurses, and other related staff to perform utilization review of drugs for the development of drug policies including researching new drugs for possible utilization management and providing education to staff pertinent to these policies.

• 4.
• Review drug/medical literature, clinical practice guidelines, and available national guidelines to support drug policy development and consultation over various medical and pharmacy clinical programs.
• 5.
• Attend CM/UM case conferences with the CM/UM nurses and Medical Directors.
• 6.
• Provide clinical support for the administration of pharmacy benefits.
• 7.
• Meet internal key performance indicators as defined by applicable The Health Plan Policies & Procedures.
• 8.
• Attend on site Interdisciplinary Care Team meetings as needed for assigned/attributed members 9.
• Document and complete peer-to-peer requests when needed.
• 10.
• Complete documentation of appeal notes for Medical Director decisions when necessary.
• 11.
• Communicate identified cost assistance issues to the benefit assistance member advocate.
• 12.
• Communicates any identified quality of care issues to Quality Improvement.
• 13.
• Communicates any identified fraud, waste, and abuse issues to Special Investigations Unit.
• 14.
• Review cases referred from Quality Improvement or Special Investigations Unit.
• 15.
• Use appropriate documentation to meet National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS) standards.
• 16.
• Adjust workflows in response to audit findings.
• 17.
• Complete pharmacy utilization management coverage determinations in accordance with The Health Plan Productivity Standards.
• 18.
• Cross train to perform functions and responsibilities of a care management pharmacist.
• 19.
• Complete care management pharmacist functions during seasonally high periods or for vacation/sick day coverage.
• 20.
• Identify new opportunities for drug management, including safety programs, and medical/pharmacy cost savings.
• 21.
• Provide relevant drug information to both in-house staff and membership upon request.
• 22.
• Conduct and document comprehensive medication reviews for eligible members of the MTM program.
• 23.
• Work as a part of an integrated team with clinical department to close gaps in care, reduce readmissions, and provide better quality of care at the right time, place, and cost to improve outcomes.

Equal Opportunity Employer

The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.

8:00am to 5:00pm 40