Position Summary: The Clinical Pharmacist at a healthcare-managed services organization plays a crucial role in ensuring optimal medication management and improving patient outcomes. This position involves reviewing prior authorization requests, evaluating pharmacy utilization, performing medication reconciliation, assisting members with medication adherence, and managing medications for chronic conditions. The Clinical Pharmacist will also assess medications for high-risk members enrolled in case management and for members with recurrent hospital admissions. This role will also assess the appropriateness of sites of service for medication administration, serve as a clinical pharmacy resource for other departments, and contribute to achieving high performance on quality pharmacy measures. Additionally, the Clinical Pharmacist will explore opportunities for improved pharmacy utilization, promote the use of biosimilars when appropriate, review specialty medications, and identify cost-containment strategies. Finally, this role will educate and train pharmacy technicians, providers, and members regarding medication management.

Essential Position Functions/Responsibilities:

• Review prior authorization requests for medications to ensure appropriateness, safety, and cost-effectiveness
• Assess clinical information and evidence-based guidelines to make informed decisions regarding medication approvals
• Evaluate pharmacy utilization patterns to ensure medical necessity and optimize medication therapy
• Identify opportunities for cost savings and recommend appropriate interventions, such as formulary changes and generic medication conversions
• Perform medication reconciliation for members to prevent medication errors and ensure continuity of care, including after hospital discharge and as needed for care management
• Collaborate with healthcare providers and patients to update medication regimens and resolve discrepancies
• Review member-specific treatment plans to identify areas of opportunity for improving blood pressure and diabetes management.
• Assist members in improving medication adherence through patient education, counseling, and developing personalized medication plans
• Collaborate with care management teams to address barriers to adherence and promote medication self-management
• Provide comprehensive medication management services to members with chronic conditions such as CHF and uncontrolled diabetes
• Collaborate with providers to optimize medication therapy, monitor treatment response, and adjust medications as needed
• Remains current with and monitors all State, Health Plan, NCQA, and other regulatory bodies to ensure compliance with the Clinical Services Department
• Serve as a clinical pharmacy resource for other departments, including Quality and Marketing
• Attend rounds and interdisciplinary meetings to provide expert pharmacy input on inpatient and SNP members
• Contribute to achieving excellent performance on quality pharmacy measures, such as statin use in diabetes or cardiovascular disease
• Identify areas for improvement and collaborate with the healthcare team to implement strategies to enhance medication-related outcomes
• Review specialty medications, including those for transplant and oncology, for appropriateness and cost-effectiveness
• Collaborate with providers, specialty pharmacies, and members to ensure optimal therapy outcomes
• Identify opportunities for cost containment through formulary non-compliance interventions and brand-to-generic medication conversions
• Monitor formulary compliance and work with the pharmacy team to implement cost-effective medication strategies
• Educate healthcare providers and members on medication management, adherence strategies, and potential drug interactions
• Develop educational materials and participate in training sessions to enhance medication-related knowledge for pharmacy staff, providers, and members

Qualification Requirements:
Skills, Knowledge, Abilities

• Clinical pharmacy experience in a healthcare or managed services organization setting is preferred
• Strong knowledge of pharmacy practice guidelines, formulary management, and medication therapy management
• Experience with medication reconciliation, medication adherence programs, and chronic disease management
• Familiarity with specialty medications, including their utilization management and adherence challenges
• Understanding of quality measures related to medication management and pharmacy utilization
• Excellent communication skills to effectively interact with healthcare providers, patients, and interdisciplinary teams
• Strong analytical and problem-solving abilities to interpret and evaluate complex medication-related data
• Ability to work independently, prioritize tasks, and manage multiple responsibilities
• Continuous learning mindset to stay updated with emerging pharmacy practices, guidelines, and regulations

Training/Education:

• Doctor of Pharmacy (PharmD) degree from an accredited institution is required
• Current pharmacist licensure in the state of New York
• Completion of a pharmacy residency preferred

Experience:

• Minimum of five years of management experience in a managed care environment
• Minimum of three years in medication management
• Experience with pharmacy quality measures
• Experience with utilization management and quality improvement processes
• Experience with claims processes
• Experience with provider/member/staff education

🔗 Our website: HealthCare Partners
Base Compensation: $120,000-$125,000 annually
Bonus Incentive: Eligibility based off organizational performance
💼 Benefits: Fully paid Medical & Dental employee coverage + robust benefits package (PTO, 401k, FSA, Tuition Reimbursement, etc.)

Job Disclaimer:
The above job description outlines the general scope and responsibilities of the position. It is not intended to be an exhaustive list of duties, skills, or qualifications required. Responsibilities may evolve based on business needs.

Department: Clinical Services This is a non-management position This is a full time position