RemoteRemote work requires HR approval and may include periodic mandatory visits to the main campus.
About the job
Requirements
Two or more years of experience in a managed care pharmacy setting or successful completion of a one-year Pharmacy Managed Care residency.
A Doctor of Pharmacy (Pharm.D.) from an accredited institution is required.
An active, unrestricted, and unencumbered Registered Pharmacist license issued by the California State Board of Pharmacy is required.
Strong clinical knowledge of current medical treatment protocols and clinical practice guidelines.
Working knowledge of regulatory standards and timelines for Medi-Cal, Medicare, and Covered California lines of business.
Proficiency with health plan electronic medical records systems such as MHK and Meditrac.
Strong drug information research skills.
Ability to communicate and work effectively with a variety of stakeholders and maintain positive working relationships with internal and external contacts at all levels.
Availability for schedules that may include evenings, holidays, and weekends based on business needs.
Eligibility for telecommuting or remote work is subject to completing necessary steps and receiving Human Resources approval.
Responsibilities
Perform patient-specific medication reviews and develop recommendations using established medical treatment protocols and clinical practice guidelines in compliance with regulatory timelines and standards.
Evaluate and adjudicate prior authorization requests for medical drugs and review drug claims for clinical appropriateness.
Perform Comprehensive Medication Reviews in compliance with Centers for Medicare & Medicaid Services standards and timelines.
Evaluate and develop medication adherence recommendations for members and prescribers; coordinate with members, prescribers, and pharmacies to ensure patients obtain medications and understand instructions for use.
Evaluate and develop patient-specific recommendations supporting pharmacy clinical quality priorities, including HEDIS, MCAS, and STARS measures.
Resolve medication and pharmacy issues for members triaged to pharmacy from the Member Services Call Center or other internal departments.
Assist with formulary implementation, management, and maintenance.
Communicate verbal and written clinical recommendations to members, prescribers, and pharmacies regarding medication use, medication adherence, therapy changes, and risks.
Initiate outbound calls to members and prescribers to explain clinical recommendations developed during clinical medication reviews.
Serve as a subject matter expert for internal and external regulatory and operational audits, projects, quality improvement process enhancements, LEAN projects, and other IEHP initiatives.
Perform other duties as assigned by Pharmacy Leadership to support Health Plan operations.
Desired Qualifications
One year of medical drug prior authorization and/or Medication Therapy Management experience.
Bilingual ability.
Overview
This is a short-term assignment.
What you can expect!
The Clinical Pharmacist – Pharmaceutical Services is responsible for providing patient-specific medication reviews and developing recommendations for medical drug utilization management (RxUM), Medication Therapy Management (MTM), medication adherence, pharmacy clinical quality, including but not limited to, HEDIS, MCAS and STARS measures, and member issue resolution. This position will resolve medication and pharmacy issues for members who are triaged to pharmacy from the Member Services Call Center or other internal departments. The Clinical Pharmacist – Pharmaceutical Services will communicate verbal and written clinical recommendations to members, prescribers, and pharmacies. The Clinical Pharmacist – Pharmaceutical Services will serve as a subject matter expert for audits, projects, quality improvement process enhancements, LEAN projects and other IEHP initiatives. The position may be assigned to a specific area or work in multiple areas on a rotating basis.
Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Additional Benefits
Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.
Competitive salary.
CalPERS retirement.
State of the art fitness center on-site.
Medical Insurance with Dental and Vision.
Life, short-term, and long-term disability options
Career advancement opportunities and professional development.
Wellness programs that promote a healthy work-life balance.
Flexible Spending Account – Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance
Key Responsibilities
Perform patient-specific medication reviews and develop recommendations using established medical treatment protocols and clinical practice guidelines in compliance with regulatory timelines and standards
Medical drug utilization management (RxUM) - Evaluate adjudicate prior authorization requests for medical drugs. Evaluate and review drug claims for clinical appropriateness
Medication Therapy Management (MTM) - Perform Comprehensive Medication Reviews (CMR) in compliance with CMS standards and timelines
Medication adherence - Evaluate and develop medication adherence recommendations to members and prescribers. Coordinates with members, prescribers, and pharmacies to assure patient obtains medication and understands instructions for use
Pharmacy Clinical Quality, including but not limited to, HEDIS, MCAS and STARS measures - Evaluate and develop patient-specific recommendations to support pharmacy clinical quality priorities
Member issue resolution - Resolve medication and pharmacy issues for members who are triaged to pharmacy from the Member Services Call Center or other internal departments
Formulary implementation, management, and maintenance assistance
Communicate verbal and written clinical recommendations to members, prescribers, and pharmacies regarding medication use, medication adherence, therapy changes, and risks. Initiate outbound calls to members and prescribers to explain clinical recommendations that were developed during the clinical medication reviews
Act as subject matter expert (SME) for internal and external regulatory and operational audits, projects, quality improvement process enhancements, LEAN projects and other IEHP initiatives.
Any other duties required as assigned by Pharmacy Leadership ensuring Health Plan operations are successful
Qualifications
Education & Requirements
Two (2) or more years of experience in managed care pharmacy setting -OR- successful completion of a one (1) year Pharmacy Managed Care residency
One (1) year of medical drug prior authorization and/or Medication Therapy Management experience preferred
Doctor of Pharmacy (Pharm. D.) from an accredited institution required
Possession of an active, unrestricted, and unencumbered Registered Pharmacist license issued by the California State Board of Pharmacy required
Key Qualifications
Strong clinical baseline knowledge of current medical treatment protocols and clinical practice guidelines
Working knowledge of regulatory standards and timelines for Medi-Cal, Medicare, and Covered California lines of business
Bilingual preferred
Proficiency with health plan electronic medical records systems (i.e. MHK, Meditrac)
Excellent written and verbal communication skills
Strong drug information research skills
Excellent communication and interpersonal skills
Detail oriented
Ability to communicate and work effectively with a variety of stakeholders and maintain positive working relationships with internal and external contacts at all levels
Schedule will adjust based on business need which may include evenings, holidays, and weekends
Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval
All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership
Start your journey towards a thriving future with IEHP and apply TODAY!
Work Model Location
Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership)
Schedule will adjust based on business need which may include evenings, holidays, and weekends.
Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.