Medicare Clinical Pharmacist Job at Premera Blue Cross
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This exciting new position will be part of an innovative, multidisciplinary team of health care professionals that will build and deliver a new clinical management model to address the needs of our Medicare members. This new role will offer you the opportunity to leverage your ambulatory care experience to positively influence health outcomes for program participants.
The Medicare Clinical Pharmacist contributes to the development of clinical pharmacy programs that ensure clinically appropriate and cost-effective medication use by researching and analyzing data and making recommendations to Pharmacy leadership. The incumbent assists in implementing and administering these programs. The incumbent supports drug utilization management strategies and programs for Pharmacy, Medical Services, Care Management, Case Management, Disease Management departments and HEDIS Clinical Quality measures.
What you’ll do:
- Support medical management and clinical pharmacy initiatives of Premera companies in support of commercial and government lines of business through research, analyses, and administration of clinical drug utilization management programs.
- Provide clinical drug utilization management, formulary management, and business support to key internal and external stakeholders.
- Support and assist in administering Pharmacy Prior Authorization and other clinical pharmacy programs.
- Provide clinical drug information support to stakeholders across the company through researching clinical cases and standard of care algorithms.
- Perform drug/medication therapy management servicesto support the management of drug utilization on the medical benefit, including case and disease management.
- Identify and help resolve drug-related issues/problems in concert with medical services staff (medical directors, case managers and disease managers) to optimize medication therapy and to improve clinical outcomes
- Assist case managers in identifying and eliminating barriers to care. Provide Personal Medication List (PML) through comprehensive medication reconciliation, patient-specific Medication Action Plan (MAP) and written/ verbal communication and feedback to healthcare providers.
- Provide telephonic consultation and as required, visits to provider clinics and member homes.
- Help design drug therapy components of disease management algorithms.
- Recommend appropriate interventions to meet accreditation requirements (NCQA, HEDIS, etc.).
- Assist in developing medical policies for drug utilization management programs.
- Support the Specialty Pharmacy management program by recommending solutions to improve Specialty drug therapy management for high cost and complex drugs.
- Assist Pharmacy leadership in analyzing and researching pharmacy cost trends and clinical program opportunities.
- May provide consultative services to large and mid-size employer groups regarding pharmacy benefits, trends and strategic direction appropriate for their employee population.
- May educate account managers, producers and clients about pharmacy programs and benefits.
- Assist in developing and maintaining provider and member communication materials that support clinical pharmacy programs.
- Support and serve as a preceptor for pharmacy students and/or residents, introducing them to drug utilization management and care management activities.
- Perform other duties as assigned.
What you’ll bring:
- Pharmacist Degree (Required).
- Active US Pharmacist license in good standing (Required).
- Clinical pharmacy training, clinical residency training from an accredited Pharmacy program (Required).
- Two (2) years’ experience as a pharmacist (Required).
- An advanced degree (e.g. PharmD, MBA, MHA, MPH or equivalent experience).
- Experience in managed care setting.
- Experience in retail pharmacy environment.
- Experience in delivering MTM services directly to patients
- Experience in managed care setting for one year or more years and knowledge and understanding of the core elements of MTM services
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What we offer
- Medical, vision and dental coverage
- Life and disability insurance
- Retirement programs (401K employer match and pension plan)
- Wellness incentives, onsite services, a discount program and more
- Tuition assistance for undergraduate and graduate degrees
- Generous Paid Time Off to reenergize
- Free parking
Equal employment opportunity/affirmative action:
Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.
If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.
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