Clinical Pharmacist: Coverage & Care Optimizer
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Job summary
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.
Qualifications
- 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.
Responsibilities
- 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.
Skills
Education
Job description
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.
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