Clinical Pharmacist Consultant

Job Description

Overview

Clinical Pharmacist Consultant

Portland, OR; Seattle, WA; Boise, ID; Salt Lake City, UT or Telecommute from within our 4 state footprint

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 Consultant, you will provide professional and clinical expertise for Pharmacy Services’ clients in making clinical decisions based on best practices in applying evidence based medicine evaluations to determine the best quality medication choices that represent the best value in efficacy and safety. Assists in planning, developing, and implementing clinical strategies for Pharmacy Services’ clients with respect to formulary management, drug utilization management, medication therapy management programs, quality initiatives and drug information and education. Responsible for conducting peer clinical reviews.

Job Responsibilities:

• Responsible for delivering high quality clinical services for Pharmacy Services’ clients for Medication Benefit Management.
• 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.)
• Responsible for peer to peer conversations.
• Works independently within framework and guidelines to evaluate intangibles associated with cost-containment and quality improvement of prescription drug charges.
• Provides creative thinking and leadership in accomplishing goals of quality improvement and cost-effective prescription drug programs.
• Collects, analyzes, interprets, and forecasts health care cost information based on current prescribing patterns based on medication utilization reports.
• Develops position papers, medication coverage policies, formulary monographs and class reviews, and formulary coverage recommendations based on critical appraisal of the scientific literature and input from practicing physicians to ensure optimal clinical outcomes at most cost-effective level.
• 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.
• Presents and/or communicates clinical positions on medication analysis in clear, concise manner to Pharmacy Services’ clients.
• Develops and provides educational materials and correspondences to members to inform them about medication coverage choices, comparative effectiveness, and coverage determinations.
• Presents formulary and medication coverage policy considerations to internal and external decision-making bodies such as the Pharmacy and Therapeutics Committee and Medication Policy Group.
• Participates in effective relationship management with Pharmacy Services’ clients that include members, medical directors, account representatives, case managers, customer services, appeals/grievance panels, and external providers.
• 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.

Minimum Requirements:

• Clinical Pharmacist Consultant would have a Bachelor’s degree in Pharmacy or related field and four years of experience in clinical acute care/hospital setting or equivalent combination of education and experience.
• Pharmacy license. Successful completion of a pharmacy residency or advanced degree in health related field. Must be an active and unrestricted licensed pharmacist in state of practice.
• Strong clinical pharmacy background with ability to demonstrate clinical therapy skills and knowledge in a clinical care setting.
• Demonstrated success in managing professional relationships in a managed care system, medical group, hospital, or related organizations.
• Strong knowledge of prepaid health care economics and financing; pharmaceutical/healthcare industry dynamics, and provider contracting strategies, techniques, and processes.
• Strong knowledge of health care economics and financing; health care/pharmaceutical industry dynamics; and pharmacy/provider service reimbursement of medications.
• Demonstrated success in managing professional business relationships in a managed care system, medical group, hospital, or related business in health care delivery industry.
• Excellent verbal and written communication skills; strong business analytical skills and abilities; strong project management and coordination ability; ability to function effectively as a management team member.
• Knowledge of: Health Plan and benefit design structures and application; Medicare/CMS regulations and applicability in administering the Medicare Product; Pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; health care coding and payment systems (such as ICD-9, CPT, HCPCS, NDC); state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA; Compliance related activities, legislative and regulatory activities, health insurance operations, or legal research helpful.

About Us

At Cambia, we advocate for transforming the health care system. You aren’t satisfied with the status quo and neither are we. We're looking for individuals who are as passionate as we are about transforming the way people experience health care. 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.

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. We have a century of experience in developing and providing health solutions to serve our members. We had our beginnings in the logging communities of the Pacific Northwest as innovators in helping workers afford health care. That pioneering spirit has kept us at the forefront as we build new avenues to improve access to and quality of health care for the future.