Pharmacy Degree and NY State Licensure, graduated or with internship experience in a healthcare setting.
Strong customer service orientation with effective interpersonal skills.
Deep knowledge of drug information processes and research capabilities.
Relevant clinical pharmacy experience in patient management initiatives.
Ability to communicate expertly as a liaison with internal and external organizations.
Proficiency in Microsoft Word and Excel to manage documentation efficiently.
Excellent verbal and written communication skills with experience interacting with patients and healthcare professionals.
Basic understanding of CMS standards for MTM services is preferred.
Responsibilities
Lead drug utilization evaluation projects and report findings for plan and member prescribing profiles.
Conduct telephonic Comprehensive Medication Reviews with MTM program members.
Collaborate with the MTM core team to enhance program quality and effectiveness.
Provide education and coaching to patients on medication management during consultations.
Mentor pharmacy and healthcare students during their experiential rotations.
Support employer clients with clinical pharmacy expertise and consultation.
Answer queries on drug information for internal and external customers to provide timely support.
Benefits
Opportunity to work within diverse lines of business including Medicare and Medicaid.
Chance to engage in community provider support and enhance patient care outcomes.
Develop professional relationships with healthcare professionals and organizations.
Participate in professional growth opportunities and continuing education programs.
Dynamic work environment with potential for travel within New York State.
Full Job Description
Summary Description:
Utilization Management (UM) Focus: The clinical pharmacist position is responsible for and participates in a wide range of provider, patient, employer initiatives and programs. The pharmacist supports all of our lines of business which include Medicare, Commercial, Exchange (Marketplace) and Medicaid and manage quality, appropriateness, safety and cost for those member populations.
Medication Therapy Management (MTM) Focus: The MTM Pharmacist will be responsible for reviewing targeted patients' prescription and medical claims history to identify opportunities to improve therapeutic outcomes & reduce the risk of adverse events. The primary function will be telephonic consultations with our members to provide education & coaching as well as to identify potential opportunities to improve patient care. The position will also require interaction with prescribers to facilitate appropriate changes to medication regimens.
Quality/Disease management: Serves as a representative of FLRx pharmacy management on specific quality/disease management initiatives. Drug Utilization Review:
As a member of the DUR team , conducts evaluations, and prepares reports and recommendations on plan, member, provider and employer prescribing profiles
Participates in and may take leadership on specific utilization evaluation projects.
Staff, Provider, Employer Group, and customer service:
For Internal Staff/departments: Serves as a key contact and clinical pharmacy consultant on medication issues for all internal staff/departments
Employer group Support/consultation: Supports Employer Clinical Consultation Team and Sales/Marketing in serving as a clinical pharmacy expert for our employer clients
Community Providers (prescribers, physicians, pharmacy): Provides comprehensive support both directly to the providers and indirectly to the pharmacy help desk/customer service by assisting them with questions and issues arising from the community (physicians/members/pharmacy personnel)
Provides guidance, instruction and mentoring of pharmacy and other health care students involved in experiential rotations in the department
Drug information services:
Serves as a participant in the DI program by supporting/covering the provider and/or member) information hotline, answering questions, conducting literature searches and formulating drug information responses and documents
Serves as a resource to internal and external customers relative to specific therapeutic topics where the clinical pharmacist is considered a content expert
Assists in the development of clinical information documents intended for a wide range of uses, including committee support, database application, newsletters, TIP sheets, etc
MTM Focus:
Perform telephonic Comprehensive Medication Reviews with members enrolled in the MTM program
Participates in the MTM core team meeting to help maintain and improve the program
Perform physician outreach for the CMS mandated Opioid DUR initiative
Work with leadership to develop clinical programs that can assist with improving STAR measures, reduce hospital admissions and improve outcomes
Develop written documents for members and providers regarding drug therapy strategies such as inappropriate use, over/under utilization, gaps in care, etc.
Minimum Resource Qualifications:
Pharmacy Degree and NY State Licensure for a newly graduated clinical pharmacist with internship experience in an organized health care setting or in a practice environment with direct physician interaction, clinical practice, data analysis and/or benefit interpretation process experience
Must possess strong customer service orientation and the ability to interface effectively with internal and external customers
Fundamental knowledge of drug information process/references and ability to conduct research
Strong clinical pharmacy experience including participation in patient management initiatives
Able to serve as a professional, articulate and knowledgeable liaison to internal and external organizations, to foster positive relationships with our vendor/partners, and to appropriately advocate for the corporation
Strong computer skills. Proficient knowledge of Microsoft Word and Excel
Excellent verbal and written communication skills with experience communicating with patients (our members) and health care professionals
Knowledge and skill to conduct a thorough drug regimen review. Strong clinical knowledge base, kept current through continuing education and professional affiliations
Maintains confidentiality and uses only the minimum amount of protected health information (PHI) necessary to accomplish job related responsibilities
Strong computer skills. Able to learn new systems
Basic knowledge of CMS minimum standards for MTM services is desired.
Physical Requirements:
Normal office environment, with work outside of normal office hours required at times
Significant time spent at a computer and using the telephone
Frequent faced paced environment requiring ability to effectively manage multiple projects at the same time, while maintaining attention to details and accuracy- Frequent variation in tasks, at times responds to problems/emergencies or is given special projects
Very high level of interpersonal interaction. Frequent to constant interaction outside immediate work area and with external customers
Very high profile position with significant contact with outside vendors, providers and customers at the highest levels
Ability to travel frequently across New York State and neighboring areas is required. Some travel required out of area. Must have ability to travel
High problem solving abilities, recognizes problems, develops problem-solving strategies and evaluates the effectiveness of solutions
