Under the direction of the Director of Pharmacy Services, the Clinical Pharmacist is responsible for managing day-to-day operations of the pharmacy department and providing guidance and oversight to pharmacy technicians. The Clinical Pharmacist is also responsible for providing clincial expertise relative to the Alliance pharmacy drug benefit programs and participating in designing, developing, and implementing pharmacy clinical programs to promote a quality, cost-effective pharmacy benefit. This position reviews and makes determinations for outpatient pharmacy prior authorization (PA) requests and in office medical drug authorizations, reviews and manages any activities related to government agencies, such as DHCS and CMS, manages PBM processes, manages all P&T related process activities and supports the pharmacy quality programs. The Clinical Pharmacist is expected to assist department leadership with development of strategies, policies, protocols and systems that improve operational productivity, efficiency and customer service.
Principal responsibilities include:
· Oversee and manage day to day operations for the pharmacy prior authorizations (PA) process.
· Participates in pharmacy department quality initiatives, such as inter-rater reliability reviews, audits, root-cause analyses, PDSA cycles, corrective action plans, and other related activities.
· Participate in all meetings with PBM and pharmacy consultants and manage PBM related daily operation processes.
· Attend and prepare meeting materials for the Alliance’s Pharmacy & Therapeutics Committee meetings and implement the recommendations on formulary and PA guidelines including benefit coding and formulary updates on websites, PA guideline implementation, and follow up on other pharmacy related initiatives resulting from the Committee’s decision(s).
· Maintain the process for pharmacy related coverage determinations, exceptions requests, complaints, and appeals and ensure criteria and decisions are properly communicated and applied.
· Assist in ensuring pharmacy related processes are carried out in accordance with CMS requirements and other regulatory requirements.
· Prepare for submission of all Part D materials and reports to CMS and review the Part D Patient Safety Reports and other programs to improve Part D quality measures related to clinical pharmacy to raise the Medicare STAR ratings.
· Make presentations to and develop training, reports, and other communications for internal staff, employers, providers, and to other stakeholders related to clinical pharmacy issues.
· Create and maintain contents of the Alliance’s websites and portals and for member bulletin and provider bulletin in accordance with NCQA and Medicare requirements.
· Write and manage pharmacy related content for publication.
· Guide the tasks performed by the Pharmacy Services Specialist, other pharmacy staff team members and pharmacy students.
· Provide pharmacotherapy expertise, review cases, and make formal recommendations at the request of Alameda Alliance clinical staff
· Analyze pharmacy and medical utilization data to identify trends and at-risk populations; recommend and develop appropriate interventions; monitor and takes action on results.
· Identify business process improvements that are aligned with and supportive of Alameda Alliance for Health’s business goals and objectives, as well as provide thoughtful analyses and recommendations.
· Act as a preceptor for pharmacy students and residents.
· Update and maintain pharmacy program policies and procedures according to NCQA and other governing agency’s requirements.
· Complete other duties and special projects as assigned.
ESSENTIAL FUNCTIONS OF THE JOB
· Ensure completion of PA’s according to the required turn around time.
· Guide pharmacy technicians and other staff and manage various projects.
· Oversee PBM operational processes.
· Monitor and manage select clinical programs and maintain the Alliance’s Medication Formulary and Medication Guidelines.
· Manage the prior authorization process with PBM and internal staff.
· Communicate professionally, effectively and efficiently to internal and external customers
· Use MS Excel and available reporting tools to run reports identifing trends in utilization and make appropriate recommendations based on the findings
· Proactively Identify opportunies for departmental process improvement and develop.
· Ability to perform writing, reporting, administration, and analysis.
· Make verbal presentations and provide training.
· Provide the highest possible level of service to clients
· Must be flexible to learn and adapt to frequent changes.
· Comply with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.
· Constant and close visual work at desk or computer.
· Constant sitting and working at desk for up to 8 hours per day (with appropriate breaks).
· Constant data entry using keyboard and/or mouse.
· Frequent use of telephone headset.
· Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
· Frequent lifting of folders and other objects weighing between 0 and 30 lbs.
· The standard work hours for this position could change based on changes to rules, regulations, or business need.
· This position may require occasional on-call weekend and holiday work.g
·Frequent walking and standing.
· Occasional driving of automobiles.
EDUCATION OR TRAINING EQUIVALENT TO:
· Current and unrestricted California pharmacist license required.
· Completion of a Post-Graduate Year 1 (PGY1) Pharmacy Residency preferred.
· Completion of a PGY1 Managed Care Pharmacy residency highly preferred
· Additional certifications by the Board of Pharmacy Specialties (BPS) preferred (e.g., BCACP, BCPS).
MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:
· One to three years of experience in managed care, hospital, or retail pharmacy required.
SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):
· Thorough clinical knowledge of therapeutic drug utilization and ability to apply appropriate clinical guidelines to real-world cases.
·Strong problem solving skills required.
· Excellent written and verbal communication skills required.
· Ability to work well in an interdisciplinary team where you will be frequently asked to help resolve pharmaceutical problems.
· Ability to make thoughtful decisions and exercise sound judgment required.
· Experience with a health plan, PBM, or history of conducting clinical exception reviews preferred.
· Experience with advanced functions of Microsoft Excel and analytic skills preferred
· Experience with developing and implementing clinical programs preferred.
· Experience with Medicare Part D guidelines and requirements preferred.
· Proficient experience in Microsoft Office suite and pharmacy programs.
· Strong organization, time management and project management skills and multi-tasking abilities.
· Knowledge of appropriate state and federal pharmacy and managed care regulations.
· Ability to commit to and facilitate an atmosphere of collaboration and team work.
· Strong professional writing and citation skills.
$110,000 - $177,290/annually