Pharmacy - Managed Care Clinical Pharmacist 146-2002

JOB SUMMARY:

The Managed Care Clinical Pharmacist will provide clinical pharmacy support to the CommunityCare Pharmacy Department including development of criteria for medications requiring a prior authorization, management of the drug utilization protocol, clinical support for the CMS Medication related STARs Measures, Medication Therapy Management (MTM) outreach, and other clinical duties as needed.  The ability to influence members and providers to act is important. This position will also work closely with the Patient’s at Risk Committee, reviewing data to identify and investigate possible medication related fraud, waste, and abuse. 

KEY RESPONSIBILITIES:

• Medication CMS Stars Measures – Provide support to the pharmacy and quality department for medication related Stars Measures. Analyze data, identify areas of opportunity, contact members to identify barriers.
• Medication Therapy Management (MTM) – Support the Medication Therapy Management Program for qualifying members. Review MTM gaps and complete Comprehensive Medication Reviews with qualifying members to support the program.
• P&T Committee Clinical Support - Work with Director of Pharmacy on development of clinical presentations and drug utilization review programs. Provide clinical input to administrative staff in the preparation of Committee minutes.
• Clinical Liaison to PBM - Work with PBM as directed by the director of pharmacy to support clinical programs, identify areas to improve quality and reduce costs.
• Formulary Development – Work with the Director of Pharmacy on formulary development and maintenance with P&T Committee and PBM to assure accuracy of adjudication files, CMS files, print and web formulary files. 
• Prior-Authorization Reviews – Review medication requests that require a prior authorization and approve or deny based upon established criteria or clinical data provided.
• Internal/External Meetings - Provide clinical pharmacy input at various internal and external meetings, as necessary.
• Perform other duties as assigned.

QUALIFICATIONS:

• Demonstrated understanding and application of managed care concepts and terminology.
• Extensive experience in management of pharmacy clinical programs.
• Proficient in Microsoft applications.
• Successful completion of Health Care Sanctions background check.
• Excellent analytical, organizational, and decision making skills.
• Successful completion of Health Care Sanctions background check. (Is this the same as the line above?) Yes. I deleted the precious one.  Possess strong oral and written communication skills.

EDUCATION/EXPERIENCE:

• Graduation from an accredited School of Pharmacy. PharmD preferred.
• Current and active unrestricted license to practice pharmacy in the state of Oklahoma.
• Minimum of 3 years work experience in a managed health care environment specific to pharmacy management activities preferred.
• 5 years clinical pharmacy experience.
• Managed care and long-term care pharmacy experience preferred.