Population Health Clinical Pharmacist NE

Banner Health; Mesa (AZ); On-site; USD 120,000 - 150,000; Full time

Benefits offered by this job

Competitive wages

Paid orientation

Flexible schedules

Weekly pay

403(b) Pre-tax retirement

Employee Assistance Program

Employee wellness program

Discount Entertainment tickets

Restaurant/Shopping discounts

Auto Purchase Plan

Job summary

Banner Health is seeking a Population Health Clinical Pharmacist to review prior authorization requests and chart notes to ensure criteria are met. The role involves communicating decisions to providers and members and documenting actions per templates.

The position emphasizes utilization management, care management, and pharmacy quality responsibilities across Banner Health Insurance Division, with a focus on improving member and provider experiences and cost efficiency.

Qualifications

• Must have a degree in Pharmacy from an accredited College of Pharmacy.
• Completion of an accredited PGY1 residency or 3 years clinical experience in managed care/ambulatory care.
• Current unrestricted pharmacy license in the applicable state within 90 days of hire.
• Experience with health plan pharmacy components and CMS/Part D guidance is preferred.
• Strong verbal/written communication and collaboration with providers and staff.

Responsibilities

• Manage pharmacy services for Insurance Division members across commercial, Medicare, Medicaid plans.
• Conduct utilization management reviews and adjudicate prior authorization requests and appeals.
• Develop and support clinical programs to improve care quality and reduce costs.
• Collaborate with health plan leaders, providers, and teams to optimize outcomes.

Skills

Managed care experience

Clinical pharmacy skills

Communication skills

Analytical ability

Education

Doctor of Pharmacy (PharmD)

PGY1 residency or 3 years clinical experience

Tools

PC-based productivity tools

Job description

Primary City/State:Mesa, ArizonaDepartment Name:Banner Staffing Services-AZWork Shift:DayJob Category:PharmacyPharmacy careers are better at Banner Health. We are committed to developing the careers of our team members. We care about you, your career today and your future. If you’re looking to leverage your abilities – apply today.As a Population Health Clinical Pharmacist, you wil use clinical knowledge to review medication prior authorization requests against set clinical criteria. You will also review chart notes and labs from providers to ensure criteria have been met or should be denied. You'll be expected to select appropriate letter and/or fax template to notify providers/members of decision and/or request additional information and you must document all decisions following standard template. You may interact with providers (and rarely members) for additional information and/or to provide education about criteriaShifts may vary between 4-8 hours, Monday – Friday 8am – 5pm (AZ time). You will have at least 2 shifts per month but may have more based on business need. No weekend or on-call rotation.Banner Staffing Services (BSS) offers Registry/Per Diem opportunities within Banner Health. Registry/Per Diem positions are utilized as needed within our facilities. These positions are great way to start your career with Banner Health. As a BSS team member, you are eligible to apply (at any time) as an internal applicant to any regular opportunities within Banner Health.As a valued and respected Banner Health team member, you will enjoy:Competitive wagesPaid orientationFlexible Schedules (select positions)Fewer Shifts CancelledWeekly pay403(b) Pre-tax retirementEmployee Assistance ProgramEmployee wellness programDiscount Entertainment ticketsRestaurant/Shopping discountsAuto Purchase PlanRegistry/Per Diem positions do not have guaranteed hours and no medical benefits package is offered. Completion of post-offer Occupational Health physical assessment, drug screen and background check (includes; employment, criminal and education) is required.POSITION SUMMARYThis position supports all aspects of pharmacy services within the Banner Health Insurance Division, including utilization management, care management, and pharmacy quality responsibilities. This position drives optimal member experience, provider experience, and financial performance through assigned areas of work. Incumbents maintain a high degree of clinical acumen, and leverages strong organizational, communication, and execution skills to ensure the successful deployment of pharmacy benefits across all populations. This role is highly independent, and incumbents work across departments, and with internal and external stakeholders.CORE FUNCTIONS1. Provides management of pharmacy services to Insurance Division members, including commercial, Medicare, Medicaid populations within owned/operated health plans as well as value-based agreements. Identifies and stratifies members based on complex pharmaceutical care needs to optimize pharmacotherapy regimens at the patient/member level, and population level to improve overall healthcare quality and reduce costs that is consistent with acceptable standards of pharmacy practice and CMS Medicare Part D regulations and guidance. Analyzes and interprets pharmacy and medical claims reporting and other sources of clinical and economic data to generate insights and clinical service opportunities.2. Active participant and/or leader in defining, implementing, and managing clinical programs and services that improve pharmaceutical care quality and lowers costs in all Insurance Division lines of business. Programs include but are not limited to, medication therapy management, pharmacy quality measure performance, utilization management, member outreach and engagement, provider education and detailing, drug utilization reviews, or formulary monograph development.3. Maintains proficiency in all legal, regulatory, and practice standards related to CMS, AHCCCS, or out-of-state Medicaid programs. Maintains proficiency in all pharmacy related URAC, NCQA, or other applicable accreditation standards. Maintains clinical proficiency in assigned clinical area(s) through continuing education.4. Conducts utilization management reviews and adjudicates prior authorization requests and appeals. Participates in multidisciplinary appeals and grievances reviews as assigned. Takes ownership to identify and resolve utilization management issues and promotes a best-in-class member and provider experience and optimal clinical outcomes for the member.5. Communicates with and supports Insurance Division members and network providers and support staff, Health Plan leaders, and Insurance Division executives concerning pharmacy issues and programs and services. Works closely with pharmacist and pharmacy technician team members to contribute to a high-performing team.6. Applies the principles of continuous quality improvement consistent with job expectations. Incorporates quality improvement principles into other activities and projects (i.e. data collection, documentation).7. May be assigned to collaborate with technical experts to create data extracts of pharmacy, eligibility, provider, or medical claims data for health plan pharmacy utilization management and audit functions.8. Participates in student and resident learning experiences, including as primary and supportive preceptor as assigned.MINIMUM QUALIFICATIONSMust possess a degree in Pharmacy (advanced degree preferred) from an accredited College of Pharmacy.Completion of an accredited PGY1 pharmacy residency program or three years of previous clinical pharmacy experience in the managed care, community pharmacy, or ambulatory care setting.Requires current and unrestricted pharmacy licensure in the applicable state of practice within 90 days of hire date.Incumbents in Arizona are also required to provide the AZ Board of Pharmacy Wallet Card at time of hire.Requires a proficiency level in managed care/health plan or pharmacy benefits experience typically obtained in 2 years. Requires effective human relations and verbal/written communication skills and the ability to work collaboratively with community-based practitioners and the senior population is essential. An understanding of the interrelationships of health plan pharmacy components, members, and providers is required.Proficiency with PC based productivity tools (e.g. spreadsheets, word processing, e-mail) required. Needs analytical ability to support decision making; organizational ability to manage multiple tasks and projects by established deadlines.PREFERRED QUALIFICATIONSGeriatric certification is a plus; experience with Medicare Part D is a plus.Additional related education and/or experience preferred.EEO Statement:EEO/Disabled/VeteransOur organization supports a drug-free work environment.Privacy Policy:Privacy Policy