Clinical Pharmacist

Description

Remote Role; however, there maybe a few onsite meetings for which in person attendance is required.

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)

This job description is not designed to be an exhaustive list of all responsibilities, duties, and skills required of each incumbent.

• 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:

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