Clinical DUR Pharmacist

MedImpact•San Diego, CA

14d•$128,974 - $237,313

About The Position

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team! Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare. At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution! Job Description Summary The Clinical DUR Pharmacist possesses an exceptional working knowledge of Medicaid program pharmacy coverage and payment rules, along with in-depth experience in managing accounts and clinical projects. This position is dedicated to optimizing the clinical quality and cost-effectiveness of drug therapy for a state Medicaid agency and its members. The role focuses on the rational management of drug utilization, employing analytical tools and an evidence-based approach to achieve lower net costs, better health outcomes, and high levels of satisfaction for plan sponsors and their members. In addition to account/contract management responsibilities, the Clinical DUR Pharmacist serves as both the subject matter expert and the team lead for specific account(s). The Clinical DUR Pharmacist provides guidance, coordinates tasks, and when necessary, delegates tasks among junior team members to ensure service levels meet client expectations. This position collaborates with corporate resources to achieve overall account and company financial goals. It relies on data and performance indicators, along with experience and judgment, to identify and promote performance improvement opportunities that meet the aligned goals of MedImpact and the client.

Requirements

PharmD and 5+ years’ experience or equivalent combination of education and experience, and 3 years of SME in respective areas; and must hold current Tennessee Board of Pharmacy licensure or complete license reciprocity prior to contract go-live date.
To perform this job successfully, an individual should have knowledge of Microsoft Office Suite and experience with at least one business intelligent tool (IBM Cognos or Tableau preferred).
Registered Pharmacist license in good standing and the ability to obtain licensure in specific state as necessary within 6 months.
Familiar with First Databank and Medi-Span drug information.
Analytical skills required to perform drug cost expenditure impact analysis.
Exceptional communication skills and interpersonal skills to interface with clients and internal team members.
Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.
Ability to deal with problems involving a few concrete variables in standardized situations.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to write routine reports and correspondence.
Ability to speak effectively before groups of customers or employees of organization.
Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.
Composure
Decision Quality
Organizational Agility
Problem Solving
Customer Focus
Drive for Results
Peer Relations
Time Management
Dealing with Ambiguity
Learning on the Fly
Political Savvy

Responsibilities

Manages the TennCare DUR program and processes.
Monitors contractual Service Level Agreements (SLAs) related to clinical services for managed account(s) and reports to leadership if risks are observed.
Provides recommendations to assigned clients that align with the clients' goals of achieving lower net costs and high clinical quality.
Strategic recommendations may include benefit design and Preferred Drug List (PDL) analysis and suggestions, provision of clinical drug information, utilization management criteria development, Pharmacy & Therapeutics (P&T) support and participation, recommendations for rational drug PDL positioning, online system edits and restrictions, ongoing clinical product evaluations, and recommendations regarding client pharmacy benefit utilization and performance trends.
Offers clinical and Medicaid consultative services in accordance with contracted services.
Acts as an integral part of designing, developing, and driving the clinical components of the assigned account team's strategic and financial goals.
The CAE II focuses on using a variety of analytical tools and clinical resources to identify opportunities that simultaneously improve the plan sponsor's quality-focused and financial performance metrics.
Identifies and promotes MedImpact's evidence-based interventions and communication programs to clients, providing documentation of recommendations for clinically appropriate and financially beneficial clinical initiatives (e.g., rebate enhancement, lower net cost, generic programs, QA programs).
Recommends clinically appropriate PDL changes, considering the lowest net cost after rebates, market shifts, and utilization.
Coordinates clinical utilization analyses and presentations to clients, ensuring timely and accurate review of plan data according to policy and offering appropriate intervention recommendations.
Coordinates the clinical support of Preferred Drug Lists during plan sponsor implementation.
Participates in quarterly state P&T meetings as stipulated by client contracts.