Population Health Clinical Pharmacist - Utilization Management/Prior Authorization

Sutter Health•Sacramento, CA

About The Position

Delivers pharmaceutical care services at the patient/member and population level through the provision of clinical services, medication literature evaluation and drug information services, utilization reviews and coverage determinations in accordance with applicable state and federal laws and regulations, patient and provider education. Analyzes large data sets to identify and execute on strategies that improve medication use across the care continuum. Exercises sound judgment and developed clinical skills to provide input to and implement the patient's plan of care based on the health status and risk factors. Gains confidence and cooperation from the patients and caregivers and applicable members of the healthcare team to improve medication use and health outcomes. Adheres to all local/state/federal regulations, codes, accreditation standards, and policies and procedures to ensure privacy and safety while delivering optimal patient care.

Requirements

Graduate of an accredited pharmacy school
Registered Pharmacist
5 years recent relevant experience
Completion of post-graduate year one (PGY1) residency or 3 years of experience in a managed care or health-system environment
Knowledge of medical terminology, generic and trade pharmaceutical names, pharmaceutical calculations and laws and regulations.
Knowledge and understanding of different Pharmacy practice settings, including narcotic delivery and procedures.
Knowledge and ability to identify and employ pharmaceutical and medical terms, abbreviations and symbols commonly used in prescribing, dispensing, and record keeping of medications.
Requires a basic working knowledge of legal requirements and accreditation standards including The Joint Commission, Title XXII, Department of Homeland Security, Drug Enforcement Administration, Food and Drug Administration, and United States Pharmacopeia.
Possess written and verbal communications skills to explain sensitive information clearly and professionally to diverse audiences, including non-medical people.
General knowledge of computer applications, such as Microsoft Office Suite (Word, Excel and Outlook), related pharmaceutical technology, electronic health records (EHR), and EPIC.

Nice To Haves

Prior Authorizations
Coverage Determinations
Integrated Delivery Systems
Managed Care
PBM

Responsibilities

Delivers pharmaceutical care services at the patient/member and population level through the provision of clinical services, medication literature evaluation and drug information services, utilization reviews and coverage determinations in accordance with applicable state and federal laws and regulations, patient and provider education.
Analyzes large data sets to identify and execute on strategies that improve medication use across the care continuum.
Exercises sound judgment and developed clinical skills to provide input to and implement the patient's plan of care based on the health status and risk factors.
Gains confidence and cooperation from the patients and caregivers and applicable members of the healthcare team to improve medication use and health outcomes.
Adheres to all local/state/federal regulations, codes, accreditation standards, and policies and procedures to ensure privacy and safety while delivering optimal patient care.