The Clinical Pharmacist II is responsible for managing various clinical pharmacy programs including but not limited to those programs involving medication adherence, medication therapy management (MTM), polypharmacy, controlled substance monitoring and/or high-risk medication monitoring. The Clinical Pharmacist II will be responsible for reviewing pharmacy related utilization across all lines of business, preparing recommendations for prescribers and members in order to modify prescription utilization and optimize therapeutic outcomes. He/she will participate in direct contact with prescribers to present recommendations and function as a contact point for case/disease management staff for pharmacy related issues. This individual will support the utilization review process for case and risk management related to the utilization of pharmaceuticals. The Clinical Pharmacist II will also participate in the review of medication-related pre-determinations, drug prior authorizations, pharmacy appeals and member grievances focused on medications. The Clinical Pharmacist II will manage clinical staff responsible for day today activities of pharmacy care management programs.
Job Duties & Responsibilities
- Responsible for day to day management of pharmacy care management programs including but not limited to medication adherence, medication therapy management (MTM), polypharmacy, controlled substance monitoring and high risk medication monitoring
- Responsible for reviewing member profile for signs of overutilization, duplication of therapy, multiple prescribers, and multiple pharmacies
- Provides recommendations in order to develop and implement improved clinical procedures and best practices to minimize and prevent future adverse medication events
- Develops as an individual, or as part of a clinical team, or in conjunction with the medical policy department and/or the PBM and presents clinical evaluations, pipeline surveillance data, formulary reviews and presentations to the corporate P & T Committee upon request
- Assists in preparation for the corporate Pharmacy and Therapeutics (P&T) Committee meetings
- Provides clinical medication therapy evaluations and recommendations to members and providers regarding the safe appropriate and cost-effective use of medication
- Assists in planning and implementing new and revised clinical programs and services
- Oversees designated key support personnel to identify and improve process issues and/or quality measures and increase workflow efficiencies
- Serves as a clinical resource and drug information specialist to medical, pharmacy, & nursing staff as well as to allied healthcare providers internally and externally
- Reviews and develop pharmaceutical treatment recommendations for case management referrals
- Supports Manager of Clinical Pharmacy Operations in the review of medication-related pre-determination requests, drug prior authorizations, pharmacy appeals and member grievances focused on medications.
- Assists the Director of Clinical Pharmacy in the advanced pharmacy practice rotations for fourth year pharmacy school students
- Review the draft medical policies and provide any recommendations for change to these policies to the Medical Policy staff
- Provide pharmacy-related educational in-services to BCBST nurses as requested
- Responds to prescriber, pharmacy provider, member appeals, grievances and complaints related to the provision of pharmaceutical services within established time periods
- Assists in the development and on-going review of the commercial, ambulatory formularies as well the development and maintenance of medial policies related to specialty pharmaceuticals for all lines of business (Commercial and Government)
- Supports pharmacy effort to achieve accreditation by external agencies
- Supports pharmacy related medical management operations to achieve corporate goals for pharmacy
- Serves on internal committees and/or workgroups and completes special projects as assigned
- Direct supervisory responsibility of clinical pharmacists and/or support staff
- Participates in local, state, and/or national professional practice organizations
- Licensed in Tennessee to practice pharmacy, or eligible for licensure in the state of Tennessee to practice pharmacy
- Doctor of Pharmacy (PharmD) degree required, with completion of a specialized residency program (e.g. managed care, drug information, pharmacotherapy, etc) or postgraduate training, preferred
- Minimum of 6 years clinical experience (broad scope preferred) required, and/or completion of 1 year residency and/or board certification required.
- Familiarity with computers and diverse software packages.
- Statistics and research design acumen.
- Solid understanding of regulatory guidelines (FDA, NCQA, EQRO) required.
- Excellent communication and presentation skills, both verbal and written are essential.
- Competency in compendia navigation and research