Clinical Pharmacist Consultant

Cambia Health Solutions • Medford, OR

1d • $121,600 - $164,500 • Remote

About The Position

Every day, Cambia’s dedicated team of Clinical Pharmacist Consultants are living our mission to make health care easier and lives better. As a member of the Pharmacy Services team, our Clinical Pharmacist Consultant provides professional and clinical pharmacy expertise in making or guiding clinical decisions based on best practices by applying evidence-based medicine evaluations to determine the best quality medication choices that represent the best value in efficacy, safety and affordability. This may include providing coverage recommendations for medications subject to prior authorization, appeals, retrospective claim reviews, and audits based on applicable medication coverage policies, member benefit contracts, and provider contracts or serving as a resource for other staff, such as medical directors or case managers, regarding clinical, policy and benefit questions and interventions. May also provide direct outreach to members and providers around current and future clinical programs that would benefit them. This role may also assist in planning, developing, and implementing clinical strategies with respect to formulary management, drug utilization management, medication therapy management programs, quality initiatives, gaps in care, peer to peer conversations and drug information and education and/or integrated pharmacy and case management strategies. Advanced responsibilities may include analyzing health care cost information, development of position papers, medication coverage policies, formulary monographs and class reviews, cross-functional projects, and/or initiatives related to the provision of pharmacy benefits that impact safety, quality and affordability – all in service of making our members’ health journeys easier. Are you a pharmacist who wants your clinical expertise to impact thousands of lives — not just the patients in front of you? Do you find yourself wanting more than a traditional pharmacy role — craving the opportunity to shape formulary strategy, influence coverage policy, and drive real change in how people access the medications they need? Then this role may be the perfect fit.

Requirements

• Bachelor's degree in Pharmacy or Doctor of Pharmacy (PharmD) or related field
• 3-5 years of experience in clinical acute care/hospital setting or equivalent combination of education and experience
• Pharmacy license.
• Must be an active and unrestricted licensed pharmacist in state of practice
• Clinical pharmacy background with ability to demonstrate clinical therapy skills and knowledge in a clinical care setting.
• Demonstrated success in managing professional relationships in a managed care system, medical group, hospital, or related organizations.
• Excellent verbal and written communication skills; strong business analytical skills and abilities; strong project management and coordination ability.
• Knowledge of pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA.
• Strong clinical pharmacy background with ability to demonstrate clinical therapy skills and knowledge in a clinical care setting.
• Strong knowledge of health care economics and financing; health care/pharmaceutical industry dynamics; and pharmacy/provider service reimbursement of medications.
• Knowledge of Health Plan and benefit design structures and application; Medicare/CMS regulations and applicability in administering the Medicare Product; health care coding and payment systems (such as ICD-9, CPT, HCPCS, NDC).
• Strong knowledge of compliance related activities, legislative and regulatory activities, health insurance operations, and legal issues.
• Ability to collaborate as part of cross functional teams, to improve clinical programs, enhance processes and share clinical information.
• Ability to work independently, to prioritize work, meet deadlines and achieve operational goals
• Employees are required to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.

Nice To Haves

• Successful completion of a pharmacy residency or advanced degree in health-related field preferred.
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

Responsibilities

• Deliver high-quality pharmacy clinical services by applying evidence-based medicine to guide clinical decisions, provide coverage recommendations for prior authorizations, appeals, retrospective claim reviews, and audits, and conduct peer clinical reviews and peer-to-peer conversations in alignment with applicable policies, member benefit contracts, and provider contracts.
• Independently evaluate cost-containment and quality improvement opportunities by collecting, analyzing, interpreting, and forecasting health care cost information based on medication utilization patterns, while providing creative leadership toward cost-effective prescription drug programs.
• Develop position papers, medication coverage policies, formulary monographs, class reviews, and coverage recommendations through critical appraisal of scientific literature and collaboration with practicing physicians to ensure optimal clinical outcomes at the most cost-effective level.
• Present clinical positions on medication analysis clearly and concisely, develop educational materials for members on coverage choices and comparative effectiveness, and present formulary and coverage policy considerations to internal and external decision-making bodies such as the Pharmacy and Therapeutics Committee.
• Identify, develop, implement, and track complex cross-functional programs and initiatives related to pharmacy benefits that impact safety, quality, and affordability, including clinical pilots with strategic partners.
• Support the development and maintenance of clinical programs — including formulary management, drug utilization management, and medication therapy management — to meet clinical, market, and member needs.
• Empower Case Management colleagues by conducting clinical reviews, responding to questions, identifying trends, and providing education to address medication management opportunities and support comprehensive member care.

Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level