Clinical Pharmacist Specialist

Presbyterian Healthcare Services; Santa Fe (NM); Remote; USD 100,000 - 176,000; Full time

Job summary

Presbyterian Healthcare Services is seeking a Managed Care Clinical Pharmacist to oversee the pharmacy benefit, including prior authorization, formulary management, regulatory compliance, and provider relationships. You will develop prescriber profiles, use predictive tools, and present data to physicians to optimize drug therapy and cost effectiveness.

The role emphasizes education, patient safety, and collaboration with PHP providers to improve outcomes and reduce costs.

Qualifications

• PharmD. or Registered Pharmacist with extensive clinical experience.
• New Mexico Board of Pharmacy License required.
• Residency or equivalent experience with 3–5 years in a clinical setting; residency and board certification preferred.

Responsibilities

• Formulary development and maintenance; P&T committee reviews and implementation decisions.
• Review discharge medications for interactions and duplications; provide recommendations.
• Clinical pharmacist-run medication management clinics; discuss polypharmacy and drug benefits with patients.
• Review PHP patient profiles for interactions and PDL compliance; consult with providers for cost-effective use.
• Provide provider education and cost-effective prescribing recommendations; share drug utilization insights with groups.
• Develop disease-management pathways and evaluate per-member-per-month pharmacy costs.
• Support regulatory compliance across pharmacy functions; collaborate with other departments.

Education

PharmD. or RPh with extensive clinical experience

New Mexico Board of Pharmacy License

Residency or Board Certification (3–5 years clinical experience)

Job description

Location Address:

Remote OfficeSanta Fe, NM 87501

Compensation Pay Range:

Minimum Offer $100,152.00Maximum Offer $175,718.40

Summary:

Provides professional consultative services for management of the PHP pharmacy benefit for all product lines. This includes oversight of the prior authorization process, formulary management, regulatory compliance, and relationships with pharmaceutical companies. Coordinates clinical programs and services offered by the department including educational programs for members, providers, and PHP staff. Another primary function of a Managed Care Clinical Pharmacist is to work with PMG and non-PMG providers to help optimize their prescribing of drug therapy. Develop customized prescriber profiles utilizing ICIS and predictive modeling tools and present this information to our providers. Provide physicians with drug information and actively participate in the development, implementation and monitoring of the PHP drug initiatives to achieve and maintain a cost effective and appropriate drug utilization as well as optimize patient care. Decrease overall pharmacy costs for PHP

Type of Opportunity: Full timeFTE: 1.00Job Exempt: YesWork Shift: Days (United States of America)

How you grow, learn and thrive matters here.

• Educational and career development options, including tuition and certification reimbursement, scholarship opportunities
• Staff Safety (a wearable badge that allows nurses to quickly and discreetly call for help when safety is a concern)
• Differentials for night/weekend shifts, higher education, certifications and various lead roles (for eligible positions)
• Malpractice liability insurance
• Loan forgiveness through the New Mexico Higher Education Department
• EPIC electronic charting system

We're all about well-being, starting with yours.

Presbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges and more.

Learn more about our employee benefits.

About Presbyterian Healthcare Services

Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

Compensation Disclaimer

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.

Responsibilities

• Work with Pharmacy Department in Formulary development and maintenance, including drug/therapeutic class reviews for the Pharmacy & Therapeutics (P&T) committee and implementation of P&T Committee decisions.
• Review drug regimens of patients discharged from in-patient settings to ensure that medications are not duplicated or interact negatively and make recommendations to the provider.
• Interact with members in clinical pharmacist run medication management clinics to discuss/review polypharmacy, disease states and/or pharmacy benefits.
• Review pharmacy profiles of PHP and paneled patients for drug interactions, duplications and Preferred Drug List (PDL) compliance.
• Consult with PHP Providers to promote patient safety, quality and cost effective use of medications.
• Provides individual provider feedback, education and recommendations on cost-effective drug prescribing.
• Provides feedback on drug utilization patterns to delegated physician groups.
• Provides educational programs for members to enhance knowledge, compliance, and cost effective therapy.
• Improves the efficiency and effectiveness of the prior-authorization process.

Additional Responsibilities

• Evaluates new drug therapy for possible inclusion on the formulary.
• Evaluates and authorizes non-formulary medication.
• Conducts drug utilization reviews and identify areas for improvement.
• Serves as a consultant in the development of Disease Management Pathways.
• Evaluates per member per month pharmacy costs and develops innovative mechanisms to favorably affect these costs while maintaining or improving quality of care.
• Interacts with other PHP departments to provide assistance with their functions including marketing, enrollment, provider services, and other functions as indicated.
• Supports PHP efforts in regulatory compliance as these requirements or standards relate to the pharmacy department function.
• Performs other functions as required.

Qualifications

• Doctorate degree in Pharmacy (PharmD.) or Registered Pharmacist (RPh) with extensive clinical experience.
• New Mexico Board of Pharmacy License required.
• Strongly Desired - Residency or equivalent experience, three to five years experience in a Clinical Setting, residency and Board Certification