Department Name:
Pharm Benefits Mgmt-Misc
Work Shift:
Day
Job Category:
Pharmacy
As a Population Health Clinical Pharmacist you serve as a member of the Population Health Medication Therapy Management (MTM) team, providing comprehensive medication management and medication adherence support for Banner Medicare Advantage and additional contracted Medicare Advantage populations.
You will perform Comprehensive Medication Reviews (CMRs) and other MTM interventions, evaluating the patient's complete medication regimen to optimize therapeutic effectiveness, identify and resolve medication-related problems, prevent adverse events, and support achievement of individualized medication therapy goals.
Additional responsibilities include conducting medication adherence monitoring and outreach, identifying barriers to adherence, collaborating with patients and healthcare providers to address medication-related concerns, and documenting clinical interventions and outcomes. You are responsible for meeting established quality, productivity, CMR, and medication adherence goals and contributing to overall team and population health performance.
Schedule: Monday-Friday, standard business hours, working remotely.
POSITION SUMMARY
This position supports all aspects of pharmacy services within the Banner Health Insurance Division, including utilization management, care management, and pharmacy quality responsibilities. This position drives optimal member experience, provider experience, and financial performance through assigned areas of work. Incumbents maintain a high degree of clinical acumen, and leverages strong organizational, communication, and execution skills to ensure the successful deployment of pharmacy benefits across all populations. This role is highly independent, and incumbents work across departments, and with internal and external stakeholders.
CORE FUNCTIONS
1. Provides management of pharmacy services to Insurance Division members, including commercial, Medicare, Medicaid populations within owned/operated health plans as well as value-based agreements. Identifies and stratifies members based on complex pharmaceutical care needs to optimize pharmacotherapy regimens at the patient/member level, and population level to improve overall healthcare quality and reduce costs that is consistent with acceptable standards of pharmacy practice and CMS Medicare Part D regulations and guidance. Analyzes and interprets pharmacy and medical claims reporting and other sources of clinical and economic data to generate insights and clinical service opportunities.
2. Active participant and/or leader in defining, implementing, and managing clinical programs and services that improve pharmaceutical care quality and lowers costs in all Insurance Division lines of business. Programs include but are not limited to, medication therapy management, pharmacy quality measure performance, utilization management, member outreach and engagement, provider education and detailing, drug utilization reviews, or formulary monograph development.
3. Maintains proficiency in all legal, regulatory, and practice standards related to CMS, AHCCCS, or out-of-state Medicaid programs. Maintains proficiency in all pharmacy related URAC, NCQA, or other applicable accreditation standards. Maintains clinical proficiency in assigned clinical area(s) through continuing education.
4. Conducts utilization management reviews and adjudicates prior authorization requests and appeals. Participates in multidisciplinary appeals and grievances reviews as assigned. Takes ownership to identify and resolve utilization management issues and promotes a best-in-class member and provider experience and optimal clinical outcomes for the member.
5. Communicates with and supports Insurance Division members and network providers and support staff, Health Plan leaders, and Insurance Division executives concerning pharmacy issues and programs and services. Works closely with pharmacist and pharmacy technician team members to contribute to a high-performing team.
6. Applies the principles of continuous quality improvement consistent with job expectations. Incorporates quality improvement principles into other activities and projects (i.e. data collection, documentation).
7. May be assigned to collaborate with technical experts to create data extracts of pharmacy, eligibility, provider, or medical claims data for health plan pharmacy utilization management and audit functions.
8. Participates in student and resident learning experiences, including as primary and supportive preceptor as assigned.
MINIMUM QUALIFICATIONS
Must possess a degree in Pharmacy (advanced degree preferred) from an accredited College of Pharmacy.
Completion of an accredited PGY1 pharmacy residency program or three years of previous clinical pharmacy experience in the managed care, community pharmacy, or ambulatory care setting.
Requires current and unrestricted pharmacy licensure in the applicable state of practice within 90 days of hire date.
Incumbents in Arizona are also required to provide the AZ Board of Pharmacy Wallet Card at time of hire.
Requires a proficiency level in managed care/health plan or pharmacy benefits experience typically obtained in 2 years. Requires effective human relations and verbal/written communication skills and the ability to work collaboratively with community-based practitioners and the senior population is essential. An understanding of the interrelationships of health plan pharmacy components, members, and providers is required.
Proficiency with PC based productivity tools (e.g. spreadsheets, word processing, e-mail) required. Needs analytical ability to support decision making; organizational ability to manage multiple tasks and projects by established deadlines.
PREFERRED QUALIFICATIONS
Geriatric certification is a plus; experience with Medicare Part D is a plus.
Additional related education and/or experience preferred.
Estimated Pay Range:
$62.63 - $104.39 / hourBanner Health is committed to pay equity and transparency. The posted compensation range is a reasonable estimate that extends from the lowest to the highest pay Banner Health in good faith believes it might pay for this particular job, based on the circumstances at the time of posting.This range is based on possible base salaries and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained.
