Clinical Pharmacist

State of Oklahoma•Oklahoma City, OK

8d•Onsite

About The Position

The Pharmacist provides advanced clinical and technical support to the agency's pharmacy programs. This role focuses heavily on pharmacy data analytics, system logic evaluation, and the optimization of healthcare technology platforms, including MMIS. The incumbent will analyze complex claims data, evaluate system edits, and collaborate on technical workflows to ensure program efficiency and compliance.

Requirements

Valid license to practice pharmacy in the State of Oklahoma plus 3 years of experience as a pharmacist OR A PhD in Pharmaceutical Services and a valid license to practice pharmacy in the State of Oklahoma
Thorough understanding of pharmacy program operations, Medicaid programs such as SoonerCare, and changes in the pharmaceutical industry and their impact on healthcare delivery systems.
Strong technical aptitude and database familiarity.
Advanced skills in clinical data querying, Excel, and claims analysis to evaluate system edits and program trends.
Expertise in policy development, budget planning, and vendor contract negotiation.
Ability to establish and maintain effective relationships with stakeholders.
Ability to analyze and resolve complex pharmacy issues.
Ability to design member and provider intervention programs.
Strong communication, collaboration, and strategic decision-making skills.
Accountability, financial acumen, and ability to manage complexity.
Ability to foster collaboration, embrace new technology, and ensure program compliance.

Nice To Haves

Strong technical and data analytics proficiency, including experience with Excel, reporting tools (e.g., Business Objects), or healthcare database querying.
Experience with or aptitude for pharmacy claims analysis, MMIS, Drug Utilization Review (DUR), or pharmacy benefit management (PBM) platforms.
Proven ability to quickly learn complex software systems, claims processing rules, and technical workflows.
Knowledge of Medicaid programs (such as SoonerCare / SoonerSelect) and managed care pharmacy operations.

Responsibilities

Analyzes pharmacy program and recommends interventions for cost-effective use of resources.
Analyzes claims utilization for clinical issues using MMIS, Business Objects, and Excel.
Designs and drafts member and provider intervention and education projects working with Pharmacy Management Consultants at the OU College of Pharmacy.
Supports and assists Pharmacy Director with policy development through reporting and analysis, budget planning, rule drafting, and State Plan amendments.
Supports and assists Pharmacy Director with MMIS claims processing enhancements such as new edits or audits.
Directs and monitors pharmacy program contractor activities and assists in contract language, negotiation with contractor representatives, appropriations process, agency contracting process, and invoice reconciliation for all vendor contracted activities affecting the pharmacy department. These programs include but are not limited to: State Maximum Allowable Cost, Prior Authorizations, and Drug Utilization Review.
Develops, operationalizes, and assists in the development of a disease and medication therapy management program. This function may include policy development, State Plan Amendments, CMS waivers, administrative rules, rate-setting, the RFP process, provider and vendor contracts, budgeting, and monitoring.
Collaborates with Managed Care plans for oversight, implementation, and evaluation of the SoonerSelect Pharmacy program.
Interacts with SoonerCare members regarding prescription issues while working toward resolution.
Consults with provider pharmacists and physicians related to the pharmacy program.
Consults/supports agency departments regarding pharmacy issues.
Represents OHCA regarding pharmacy issues with external stakeholders and at various meetings.
Other duties as assigned.