This job was posted by https://idahoworks.gov : For more information,
please see: https://idahoworks.gov/jobs/2269682
Pharmacy Clinical Consultant
Work from home within Oregon, Washington, Idaho or Utah
Build a career with purpose. Join our
Cause
to create a person-focused and economically sustainable health care
system.
Who We Are Looking For:
Every day, Cambia\'s dedicated team of Pharmacy Clinical Consultants are
living our mission to make health care easier and lives better. As a
member of the Health Service Organization on the High Cost team, our
Pharmacy Clinical Consultant is a pivotal position responsible for
designing, implementing, assessing, and maintaining clinical programs
and strategies that drive cost containment and clinical quality
enhancements related to pharmacy services. This role involves close
collaboration with internal stakeholders to ensure seamless alignment
with care management, provider engagement, and member engagement
strategies - all in service of creating a person-focused health care
experience.
Are you a Pharmacist passionate about driving clinical excellence and
cost containment in pharmacy services? Are you a healthcare professional
looking for a new challenge? Then this role may be the perfect fit.
What You Bring to Cambia:
Qualifications:
- Bachelor\'s degree in a health related field
- 4 years of experience in ambulatory care/hospital/pharmacy benefit
management
- Pharm.D. degree and experience in pharmacy benefit management and
clinical program development is preferred
- Must be an active and unrestricted licensed pharmacist in state of
practice
Skills and Attributes:
- Possesses in-depth knowledge of the pharmacy benefit management
industry, including benefit design, pharmacy products and services,
and competitive offerings, as well as client needs.
- Demonstrates strong understanding of healthcare economics and
financing, industry dynamics, and pharmacy/provider service
reimbursement of medications.
- Exhibits strong clinical knowledge and understanding of
evidence-based medicine principles, with the ability to apply them
to formulary design, medication coverage policies, and other
medication management solutions.
- Proven ability to interpret complex clinical information, claims
data, and regulatory requirements to develop practical and creative
product development solutions.
- Demonstrates leadership and interpersonal skills, with the ability
to effectively manage projects and vendor relationships.
- Possesses excellent verbal and written communication skills, strong
business analytical skills, and project management and coordination
abilities.
- Proven success in managing professional business relationships in
the healthcare delivery industry, including managed care systems,
medical groups, and hospitals.
- Familiarity with health plan and benefit design structures,
Medicare/CMS regulations, and pharmaceutical products, including
orals, injectables, infusion products, and chemotherapy.
- Knowledge of healthcare coding and payment systems, such as ICD-10,
CPT, HCPCS, and NDC.
- Understanding of state and federal laws and rules regarding pharmacy
practice and healthcare industry regulations, including DOLI, PPACA,
and HIPAA.
- Familiarity with compliance-related activities, legislative and
regulatory activities, health insurance operations, and legal
research is desirable.
What You Will Do At Cambia:
- Lead the identification of clinical areas for product development
and execute clinical programs to meet member needs, including pilots
with strategic partners.
- Stay abreast of industry trends and market differentiating clinical
strategies to maintain competitive knowledge.
- Analyze utilization trends and quality outcomes, providing creative
solutions to support cost containment, quality improvement, and
regulatory compliance.
- Evaluate and select vendor clinical offerings that align with
Regence\'s clinical and business goals, and negotiate, monitor, and
manage vendor performance.
- Contribute to pharmacy clinical strategies, formulary development,
policy development, benefit design, and utilization management
initiatives.
- Regularly assess and refine clinical product offerings to maintain a
competitive portfolio with strong ROI, and design/improve clinical
and operational processes to support exceptional member experiences
and operational efficiency.
- Provide consultative expertise to strategic partners, plan
leadership, purchasers, and other stakeholders, and mentor/coach
pharmacy students and residents as needed.
- Provide consultative expertise and coaching to internal RN and SW
case managers, attend clinical rounds when appropriate to support
care management process and initiatives.
#LI-Remote
The expected hiring range for a Pharmacy Clinical Consultant is
\$119,900 - \$162,200 an hour depending on skills, experience,
education, and training; relevant licen
