Clinical Pharmacist

Description

Summary

• This position serves as internal and outward-facing, dedicated clinical resource responsible for quality measures supporting the pharmacy department in identifying Star/HEDIS measure needs and expectations, and developing and managing initiatives to achieve 5 stars.
• The position has oversight responsibilities driven by metrics to manage vendors, retail pharmacy, prime, Magellan and health systems to deliver outcomes as outlined in different programs as well as reporting to internal stake holders

Major Responsibilities (4 to 8 in total)

• Clinical pharmacist will be responsible for managing outreach efforts and pull-through for Star/HEDIS clinical programs.
• Coordinate between the pharmacy department, health systems, and Magellan.
• Clinical pharmacist will be responsible for driving results to obtain 5-Stars for Medicare Part D Star clinical programs including Adherence (DM, RAS, Statins), SUPD, and CMRs for MTM.
• Oversee the daily clinical activities related to Star/HEDIS measure goals for various health systems.
• Ensure clinical goals and objectives are met.
• Identify problems related to Star/HEDIS measures that require a clinical solution, implement and monitor clinical pharmacy solutions in support of Client’s Star/HEDIS goals to save money and improve care.
• Major responsibility is to serve as clinical liaison between Client pharmacy department and health systems, assisting with managing overall relationship and driving adoption of recommended clinical solutions.
• Develop, review and monitor clinical programs, therapeutic initiatives, pathways of care and other drug use policies and practices in support of Star/HEDIS initiatives.
• Works closely with the pharmacy department managers, vendors, and health systems to ensure execution of programs.
• Maintain continuity among health systems by communicating and documenting program design and execution in accordance with pharmacy department expectations.
• Track, analyze and report on patient interventions, interactions and findings of disease management activities.
• With support of the Client data team, develop and track the appropriate metrics to monitor the quality, care, and cost impact of the Star/HEDIS program and monitor overall healthcare trends within the Medicare populations.
• Conduct member, provider, and pharmacy outreach/interventions and Comprehensive Medication Reviews as needed to achieve Stars goals.
• The position requires communication across all departments; an understanding of the strategic impact of the programs; and extensive knowledge of how the Star/HEDIS programs integrate with other clinical initiatives.
• Understand the financial impact of all clinical recommendations: Programs must address the impact on customers, operations, program integrity, pricing, quality and satisfaction.

Functional Competencies

Qualifications

Education/Experience:

• BA/BS in Pharmacy or PharmD

Field(s) of study:

• Pharmacy

Experience:

• 2-5years

Experience:

• Health plan or Medicare clinical customer service or Retail management position . Project management experience and knowledge of health plans or Medicare industry. CMS Star/HEDIS measure quality improvement metrics.

Industry:

• Healthcare; preferably with retail or health insurance provider.

Additional licensing, certifications, registrations:

• A current Pharmacist license in the state of New Jersey

Knowledge:

• CMS Star/HEDIS measures.

Skills and Abilities:

• Able to receive assignments in the form of high level objectives and independently establish detailed goals to meet objectives.
• Strong interpersonal skills.
• Excellent oral and written communication skills.
• Ability to function independently and as a team member.
• Good organization and time management, with the ability to manage multiple tasks.
• Proven ability to plan, organize, schedule, direct, control and monitor project activities.
• Able to perform basic financial analysis.
• Ability to interact at a high level with external contacts.
• Develop reporting and tracking documents with visuals

Computer Skills:

• MS Office Suite, access, excel, project management, power point