Clinical Pharmacist Consultant
Cambia Health Solutions

Job Info

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Clinical Pharmacist Consultant

Telecommute Option - Must reside in ID, OR, UT or WA


WHO WE NEED

Provides professional and clinical pharmacy expertise in making or guiding clinical decisions based on best practices by applying evidence-based medicine evaluations to determine the best quality medication choices that represent the best value in efficacy, safety and affordability. This may include providing coverage recommendations for medications subject to prior authorization, appeals, retrospective claim reviews, and audits based on applicable medication coverage policies, member benefit contracts, and provider contracts or serving as a resource for other staff, such as medical directors or case managers, regarding clinical, policy and benefit questions and interventions. May also provide direct outreach to members and providers around current and future clinical programs that would benefit them.

This role may also assist in planning, developing, and implementing clinical strategies with respect to formulary management, drug utilization management, medication therapy management programs, quality initiatives, gaps in care, peer to peer conversations and drug information and education and/or integrated pharmacy and case management strategies. Advanced responsibilities may include analyzing health care cost information, development of position papers, medication coverage policies, formulary monographs and class reviews, cross-functional projects, and/or initiatives related to the provision of pharmacy benefits that impact safety, quality and affordability.

Normally to be proficient in the competencies listed below:

Clinical Pharmacist Consultant Senior would have

• Bachelor's degree in Pharmacy or Doctor of Pharmacy (PharmD) or related field
  
• 5+ years of experience in clinical acute care/hospital setting
  
• Or equivalent combination of education and experience.
  

Preferred Key Experience:

• Use evidence-based-medicine principles to critically appraise newly FDA-approved medications and indications to inform coverage strategy, formulary placement, and prior authorization policy.
  
• Synthesize clinical, financial, and practical data to make cohesive recommendations on medication positioning.
  
• Participate in cross-functional committees such as, but not limited to, Pharmacy and Therapeutics (P&T), Oncology P&T Subcommittee, and Medication Policy Group.
  
• Perform other functions such as, but not limited to, formulary development and maintenance, coverage policy development and maintenance, claim system coding, and prior authorization review of select medications.
  
• Advocate for the best-in-class medication cost management for hundreds of disease states in a complex health care environment.
  
• Exhibit excellent verbal and written communication skills to convey drug positions both internally and externally, including leadership, clinical partners, non-clinical partners, providers, and members.
  
• Display strong clinical acumen and problem-solving skills.
  
• Able to work independently and willing to learn new ways to think about clinical evidence and medication management.
  

Required Licenses, Certifications, Registration, Etc.

Pharmacy license. Successful completion of a pharmacy residency or advanced degree in health-related field preferred. Must be an active and unrestricted licensed pharmacist in state of practice.

YOUR ROLE:

• Responsible for delivering high quality pharmacy clinical services for Medication Benefit Management.
  
• May be responsible for conducting peer clinical reviews. (The medical director has the responsibility to determine that the peer clinical reviewers are qualified to render a clinical opinion for items under review.)
  
• May be responsible for peer to peer conversations.
  
• Works independently within framework and guidelines to evaluate intangibles associated with cost-containment and quality improvement of prescription drug charges.
  
• Provide coverage recommendations for medications subject to prior authorization, appeals, retrospective claim reviews, and audits based on applicable medication coverage policies, member benefit contracts, and provider contracts.
  
• Provides clinical decision-making based on best practice in applying evidence-based medicine process in determining medications that have best value for efficacy and safety.
  
• Develops and provides educational materials and correspondences to members to inform them about medication coverage choices, comparative effectiveness, and coverage determinations.
  
• Provides creative thinking and leadership in accomplishing goals of quality improvement and cost-effective prescription drug programs.
  
• Collects, analyzes, interprets, and forecasts health care cost information based on current prescribing patterns based on medication utilization reports.
  
• May develop position papers, medication coverage policies, formulary monographs and class reviews, and formulary coverage recommendations based on critical appraisal of the scientific literature and input from practicing physicians to ensure optimal clinical outcomes at most cost-effective level.
  
• Presents and/or communicates clinical positions on medication analysis in clear, concise manner.
  
• May present formulary and medication coverage policy considerations to internal and external decision-making bodies such as the Pharmacy and Therapeutics Committee and Medication Policy Group.
  
• Identify, develop, implement and track complex cross-functional programs, projects, and initiatives related to the provision of pharmacy benefits that impact safety, quality and affordability
  
• May support the execution and assist the development and maintenance of clinical programs to meet clinical, market, and member needs, including clinical pilots with strategic partners
  
• May empower Case Management to provide comprehensive member support by conducting clinical reviews, responding to questions, and identifying trends and providing education to address medication management opportunities
  
• Provide leadership and deep subject matter expertise in cross-functional programs, projects, and initiatives related to the provision of pharmacy benefits that impact safety, quality, and affordability
  
• Develops effective relationship management with customers, business partners, and stakeholders that include members, medical directors, account representatives, case managers, customer services, appeals/grievance panels, and external providers.
  
• Provides coaching, mentorship and training to other Clinical Pharmacist Coordinators in department
  
• Provides expert analysis and data interpretation in support of strategy development, program implementation and evaluation. Acts as leader within the team.
  

WHAT YOU BRING:

• Clinical pharmacy background with ability to demonstrate clinical therapy skills and knowledge in a clinical care setting.
  
• Demonstrated success in managing professional relationships in a managed care system, medical group, hospital, or related organizations.
  
• Excellent verbal and written communication skills; strong business analytical skills and abilities; strong project management and coordination ability.
  
• Knowledge of pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA.
  
• Strong clinical pharmacy background with ability to demonstrate clinical therapy skills and knowledge in a clinical care setting.
  
• Strong knowledge of health care economics and financing; health care/pharmaceutical industry dynamics; and pharmacy/provider service reimbursement of medications.
  
• Knowledge of Health Plan and benefit design structures and application; Medicare/CMS regulations and applicability in administering the Medicare Product; health care coding and payment systems (such as ICD-9, CPT, HCPCS, NDC).
  
• Strong knowledge of compliance related activities, legislative and regulatory activities, health insurance operations, and legal issues.
  
• Ability to collaborate as part of cross functional teams, to improve clinical programs, enhance processes and share clinical information.
  
• Ability to work independently, to prioritize work, meet deadlines and achieve operational goals
  
• Demonstrated success in leading and being accountable for complex programs, projects, and initiatives within a complex and diverse managed care, health plan, or similar healthcare setting.
  
• Critical and strategic thinking and prove experience solving problems and completing and/or leading assigned projects timely and accurately.
  
• Proven ability to provide analysis and data interpretation in support of strategy development, program implementation and evaluation.
  
• Demonstrated ability to lead and mentor other Clinical Pharmacist Consultants
  

#LIremote

The base pay annual salary range is: 110.5k-180.5k

The bonus target for this position is 15%

At Cambia, we take a variety of factors into account when creating a job offer, including your skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. While we offer competitive salaries, in general, we rarely hire candidates at or near the top of the salary range.

Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:

• medical, dental, and vision coverage for employees and their eligible family members
  
• annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
  
• paid time off and company holidays
  
• up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)
  
• up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
  
• one-time furniture and equipment allowance for employees working from home
  
• up to $225 in Amazon gift cards for participating in various well-being activities for a complete list see our External Total Rewards page.
  

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

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