Cambia Health Solutions

Clinical Pharmacist Consultant. This may include providing coverage recommendations for medications subject to prior authorization, appeals, retrospective claim reviews, and audits based on applicable medication coverage policies, member benefit contracts, and provider contracts or serving as a resource for other staff, such as medical directors or case managers, regarding clinical, policy and benefit questions and interventions.. This role may also assist in planning, developing, and implementing clinical strategies with respect to formulary management, drug utilization management, medication therapy management programs, quality initiatives, gaps in care, peer to peer conversations and drug information and education and/or integrated pharmacy and case management strategies.. Provide coverage recommendations for medications subject to prior authorization, appeals, retrospective claim reviews, and audits based on applicable medication coverage policies, member benefit contracts, and provider contracts.. Clinical Pharmacist Consultant would have a Bachelor's degree in Pharmacy or Doctor of Pharmacy (PharmD) or related field and 3-5 years of experience in clinical acute care/hospital setting or equivalent combination of education and experience.

clinical pharmacist

Clinical Pharmacist Consultant Remote in ID, OR, WA, UTPrimary Job PurposeProvides professional and clinical pharmacy expertise in making or guiding clinical decisions based on best practices by applying evidence-based medicine evaluations to determine the best quality medication choices that represent the best value in efficacy, safety and affordability. This may include providing coverage recommendations for medications subject to prior authorization, appeals, retrospective claim reviews, and audits based on applicable medication coverage policies, member benefit contracts, and provider contracts or serving as a resource for other staff, such as medical directors or case managers, regarding clinical, policy and benefit questions and interventions. May also provide direct outreach to members and providers around current and future clinical programs that would benefit them.This role may also assist in planning, developing, and implementing clinical strategies with respect to formulary management, drug utilization management, medication therapy management programs, quality initiatives, gaps in care, peer to peer conversations and drug information and education and/or integrated pharmacy and case management strategies. Advanced responsibilities may include analyzing health care cost information, development of position papers, medication coverage policies, formulary monographs and class reviews, cross-functional projects, and/or initiatives related to the provision of pharmacy benefits that impact safety, quality and affordability.General Functions and Outcomes<ul><li>Responsible for delivering high quality pharmacy clinical services for Medication Benefit Management.</li><li>May be responsible for conducting peer clinical reviews. (The medical director has the responsibility to determine that the peer clinical reviewers are qualified to render a clinical opinion for items under review.) </li><li>May be responsible for peer to peer conversations.</li><li>Works independently within framework and guidelines to evaluate intangibles associated with cost-containment and quality improvement of prescription drug charges.</li><li>Provide coverage recommendations for medications subject to prior authorization, appeals, retrospective claim reviews, and audits based on applicable medication coverage policies, member benefit contracts, and provider contracts.</li><li>Provides clinical decision-making based on best practice in applying evidence-based medicine process in determining medications that have best value for efficacy and safety.</li><li>Develops and provides educational materials and correspondences to members to inform them about medication coverage choices, comparative effectiveness, and coverage determinations. </li></ul>Minimum Requirements<ul><li>Clinical pharmacy background with ability to demonstrate clinical therapy skills and knowledge in a clinical care setting.</li><li>Demonstrated success in managing professional relationships in a managed care system, medical group, hospital, or related organizations.</li><li>Excellent verbal and written communication skills; strong business analytical skills and abilities; strong project management and coordination ability. </li><li>Knowledge of pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA.</li></ul>Normally to be proficient in the competencies listed above:Clinical Pharmacist Consultant would have a Bachelor's degree in Pharmacy or Doctor of Pharmacy (PharmD) or related field and 3-5 years of experience in clinical acute care/hospital setting or equivalent combination of education and experience.Required Licenses, Certifications, Registration, Etc.Pharmacy license. Successful completion of a pharmacy residency or advanced degree in health-related field preferred. Must be an active and unrestricted licensed pharmacist in state of practice.#LI-Remote

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