Federal Pharmacy – Public Health, Health Maintenance Organization, Pharmacy Benefits Management
Specialty Practice Areas:
The Clinical Pharmacist is responsible for participation in all day-to-day aspects of the Pharmacy Services Department, including but not limited to issuance of all pharmacy coverage decisions, development of policies and procedures and coordination of pharmacy benefits for members. Responsible for maintaining compliance with all state and federal legislation. Serve as a clinical resource person for Health Services staff, other internal associates and external vendors as necessary.
Provide drug coverage determinations for members with PacificSource Health Plans.
Support clinical calls with members, providers, and internal staff.
Support clinical meetings with internal and external stake holders as requested.
Review prescription formularies and criteria for needed updates based on clinical guidelines.
Lead and / or assist in projects as assigned.
Stay up to date on State and Federal regulations as they relate to health insurance coverage.
Stay up to date on quality measures pertinent to Pharmacy Services.
Act as backup for other team members and departmental functions.
Work with Clinical Pharmacy Manager and/or designee to improve processes, systems, reporting, and services provided by the department
Represent Pharmacy Services Department, both internally and externally, as requested.
Meet department and company performance and attendance expectations.
Perform other duties as assigned.
Work Experience: Three or more years of pharmacy related work-experience is preferred. Additional experience managing complex work processes is highly preferred. Prior success in healthcare integration, process development and program implementation is desirable.
Education, Certificates, Licenses: Doctor of Pharmacy degree or Registered Pharmacist, and valid state license without restriction required. Additional certifications may be needed such state specific credentials. Certification support may be available for credentials needed post-hire. Post-graduate training (examples include Residency, Fellowship, MBA, BCPS) is preferred.
Knowledge: Ability to adapt and prioritize within a fast-paced environment. High attention to detail. Knowledge and comprehension of pharmaceutical services, including federal and state statutes and regulations as they pertain to the insurance-related pharmacy services and benefits administration. Ability to assess pharmaceutical alternatives, treatment plans, drug technologies and new approaches to delivering pharmacy services. Ability to work independently and within groups with minimal supervision.
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Internal Number: 2019-531
PacificSource is anything but a typical health plan. We’re a growing, independent, not-for-profit organization with a 80-year history and reputation for service excellence. At PacificSource it is our 700+ employees that make a difference. We invest in the communities we serve by partnering with local providers to deliver high quality, accessible healthcare, and through charitable giving and personal involvement with non-profit organizations. Join us in our mission of helping people get the healthcare they need and let your work make a difference, too. We offer excellent benefits, competitive wages, and opportunities for growth and promotion. Benefits:PacificSource provides excellent benefits to ensure the well being of employees and their dependents. Employer-paid benefits include medical, vision and dental insurance, incentive program, paid time off and holidays, 401k plan, training and education opportunities, life insurance and additional voluntary programs including a flexible spending account.