Clinical Pharmacist, Case Management

Job Description

Overview

Clinical Pharmacist, Case Management

Portland, OR; Seattle, WA or Lewiston, ID

At Cambia, our values are fundamental to achieving our Cause of transforming the health care industry. They guide our actions and bring diverse perspectives together to improve the health care journey better for those we serve. All eight values are equally important and linked to the others: Empathy, Hope, Courage, Trust, Commitment, Innovation, and Accountability. These values are not just words on paper - we live them every day.

Responsibilities & Requirements

As the Clinical Pharmacist for Case Management, you will provide clinical pharmacy expertise to the Case Management team, working in collaboration with the Clinical Pharmacy Services Team, Pharmacy Benefit Manager, and Specialty Pharmacy. Responsible for providing consultative services to nurse case managers which may include performing member specific interventions through case management, provider collaboration and medication reviews. Identifies, leads, and measures the impact of pharmacy program opportunities that impact benefit cost, utilization and quality metrics.

May be involved in various initiatives to enhance pharmacy services; streamline processes; reduce administrative costs; improve operational activities and ensure regulatory compliance.

Role Responsibilities:

• Act as a clinical resource to nurse case managers regarding medication therapy.
• Evaluate medication related problems such as adverse events, therapeutic duplication, adherence to therapy, polypharmacy, and untreated disease or conditions.
• Ensure integrated approach to care. Collaborate effectively with the Clinical Pharmacy Services team and with Clinical Services staff. Provide Subject Matter Expertise and support projects or initiatives as needed to continually improve care and quality.
• Support of member, provider, and employer group communication. For example, the pharmacist may interact directly with health care providers and their staff to establish working relationships. The pharmacist may also deliver presentations and clinical consultation to employer groups regarding clinical aspects of their drug benefits.
• Use clinical pharmacy knowledge to interpret various analyses, determine what information to analyze further, and what trends or issues to report to others.
• Provide education on the appropriate use of medications to monitor and evaluate patient’s response to therapy to nurse case managers, members, or network providers.
• Provide clinical recommendations pertaining to, but not limited to, gaps in care, high risk medications, compliance and adherence, drug interactions, therapeutic substitution, and generic substitution.
• Utilize client formulary information and member specific benefits to guide appropriate medication recommendations.

Minimum Requirements:

• The Clinical Pharmacist would have a Bachelor's or Doctor of Pharmacy degree and four years of experience in a patient care setting as well as management or professional experience in a managed health care system, medical group, hospital, or related business in the health care delivery industry or an equivalent combination of education and experience. Residency certificate or advanced degree in health care administration, economics, public health, pharmacy administration, finance, or equivalent field preferred.
• Active and unrestricted Pharmacist license in state of practice.
• Board certification preferred.
• Strong clinical pharmacy background with the ability to demonstrate clinical therapy skills and knowledge in a clinical care setting.
• Excellent verbal, written, and interpersonal communication skills, including the ability to present information and effectively interact with patients, providers, colleagues, and management.
• Strong project management and coordination ability; ability to function effectively as both an individual contributor and part of a team. The ability to simplify and handle multiple complex issues/tasks effectively.
• Self-motivated, with demonstrated ability to work independently with minimal supervision.
• Ability to interpret complex clinical information, claims data and regulatory requirements to deliver quality care to patients and practical business solutions to clients as needed.
• Ability to collaborate as part of cross functional teams, to improve clinical programs, enhance processes and share clinical information.
• Demonstrated success in managing professional relationships in a managed care system, medical group, hospital, or related organizations.
• Critical and strategic thinking and proven experience solving problems and completing assigned projects timely and accurately.
• Knowledge of the following areas helpful: wide range of pharmaceutical products, health plan and benefit design; health insurance operations; Medicare/CMS regulations; state and federal laws and rules regarding the practice of pharmacy and health care industry practices.

About Us

Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check is required.

Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members more than 100 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association. If you’re seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers’ engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.