Clinical Pharmacist

Job Description

Duties & Responsibilities :

• 95% - Pharmacy Management
• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals / priorities for the department.
• Generates and analyzes claims and utilization reports to track general trends in drug utilization and to identify potential targeted utilization management activities.
• Develops and updates drug utilization criteria.
• Develops and maintains contacts and relationships with providers key to successful interaction and intervention activities.
• Participates in medication review, disease state management and other clinical quality improvement programs such as Stars and Healthcare Effectiveness Data and Information Set (HEDIS) Quality Improvement Programs, Medication Therapy Management (MTM), interdisciplinary care teams and PACE.
• Assists the Pharmacy Director and the Manager of Clinical Pharmacists in the preparation of drug monographs and utilization reports for the Pharmacy and Therapeutics committee.
• Utilizes clinical and regulatory guidelines in the review of drug prior authorization and appeals requests.
• Adheres to regulatory compliance and quality guidelines policies and procedures.
• Updates pharmacy policies and develops new policies and procedures when needed.
• Works with management to recommend, develop and implement target drug utilization intervention programs and other Drug Utilization Review / Drug Utilization Evaluation (DUR / DUE) activities.
• Works with the Manager of Clinical Pharmacists and within Medical Management (e.g., with data manager, case managers, etc.) on various data integration, disease management and outcomes projects.
• Reviews members’ medication profiles and makes recommendations to health care providers based on evidence-based medicine and national guidelines for disease management as part of

polypharmacy program.

Minimum Qualifications :

Preferred Qualifications :

Required Licensure / Certifications :

Knowledge & Abilities :

Physical Requirements (With or Without Accommodations) :

Work Environment :

If located at the 500, 505 Building or a remote work location :

If located at PACE :

If located in the Community :