Clinical Pharmacist

Quantum Recruiters; Oregon; Ibrido; USD 110.000 - 150.000; Tempo pieno

Descrizione del lavoro

PacificSource Health Plans is seeking a Clinical Pharmacist to coordinate pharmaceutical services for members, aligning coverage decisions with clinical guidelines, member needs and plan benefits.

You will review coverage requests, support Star measures, and collaborate with medical directors and the healthcare team to promote quality, cost-effective outcomes while adhering to HIPAA and applicable federal/state regulations.

Competenze

• Minimum 2 years of pharmacy-related work experience or 1 year of post-graduate training.
• Doctor of Pharmacy degree or registered Pharmacist with active state license.
• Strong knowledge of pharmaceutical services, including federal/state regulations governing insurance-related pharmacy services.

Mansioni

• Provide accurate drug coverage determinations for PacificSource Health Plans based on posted criteria and standards.
• Support Part D Star measures through personal member outreach and interventions.
• Communicate with members, providers, and internal staff via calls, coverage determination letters, and email.
• Stay up to date on State and Federal regulations related to health insurance coverage and pharmacy practice.
• Assist in department projects and participate in internal meetings as requested.
• Follow PacificSource privacy policy and HIPAA regulations.

Conoscenze

Pharmacy experience

Regulatory knowledge

Communication skills

Detail-oriented

Formazione

Doctor of Pharmacy (PharmD) or Pharmacist license

Descrizione del lavoro

The Clinical Pharmacist supports PacificSource’s mission to provide better health, better care, and better cost to the people and communities we serve by coordinating the delivery of pharmaceutical services based on the member’s specific clinical circumstances, health plan benefits, and availability of additional medical, community, or financial resources. This role reviews pharmacy coverage requests and issues determinations which promote quality, cost-effective outcomes, or supports quality measures through personal member outreach and interventions. Pharmacists work closely with other members of the healthcare team to understand the healthcare landscape and facilitate outstanding member care using fiscally responsible strategies.

Essential Responsibilities

• Provide accurate and timely drug coverage determinations for members of PacificSource Health Plans based on posted criteria, current standards of medical practice, and member-specific condition and assist Medical Directors in reviewing appeals for denied coverage determinations.
• Support Part D Star measures through personal member outreach and interventions.
• Provide effective communication for members, providers, and internal staff through various platforms such as clinical calls, coverage determination letters, and email.
• Stay up to date on State and Federal regulations as they relate to health insurance coverage and the practice of pharmacy.

Supporting Responsibilities

• Work with Clinical Pharmacy Team Leads and/or designee to improve processes and services provided by the department.
• Represent Pharmacy Services Department internally as requested.
• Support clinical meetings with internal stake holders as requested.
• Assist in projects as assigned.
• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

SUCCESS PROFILE

• Work Experience: Minimum of 2 years of pharmacy-related work experience or 1 year of post-graduate training (residency or fellowship) is required. Additional experience managing complex work processes is highly preferred.
• Education, Certificates, Licenses: Doctor of Pharmacy degree or Registered Pharmacist, and valid state license without restriction required. Additional certifications may be needed such state specific credentials.
• Knowledge: Ability to adapt and prioritize within a fast-paced environment. High attention to detail. Knowledge and comprehension of pharmaceutical services, including federal and state statutes and regulations as they pertain to the insurance-related pharmacy services and benefits administration. Ability to assess pharmaceutical alternatives, treatment plans, drug technologies and new approaches to delivering pharmacy services. Ability to work independently and within groups with minimal supervision.