Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

The Clinical Pharmacist Specialist II supports PacificSource’s mission to provide better health, better care, and better cost to the people and communities we serve by coordinating the delivery of pharmaceutical services based on the member’s specific clinical circumstances, health plan benefits, and availability of additional medical, community, or financial resources. This role provides subject matter expertise for specialized pharmacy processes and programs, such as formulary administration, Pharmacy and Therapeutics Committee work, or initiatives that promote the overall quality of the health plan. The Clinical Pharmacist Specialist II will identify opportunities and lead continuous process improvement activities that promote lean, integrated workstreams. This role will serve as a clinical liaison for other departments and external vendors as necessary, and may provide information or education on pharmacy services.

Essential Responsibilities:

• Provide subject matter expertise in a specialized pharmacy process (such as formulary management, quality or population health initiatives, or Pharmacy and Therapeutics Committee reviews) and effectively collaborate with internal partners to maximize deliverables.
• Work with Pharmacy Leadership to strategically improve processes, systems, reporting, and services provided by the department.
• Lead or support clinical meetings with internal and external stakeholders as requested.
• Lead or assist in projects as assigned.
• Assist with resident training.
• Assist training pharmacy staff in specialized workflows as assigned.
• Collaborate with pharmacy leadership to create and maintain training documents
• Stay up to date on State and Federal regulations as they relate to health insurance coverage and the practice of pharmacy.
• Stay up to date on quality measures pertinent to Pharmacy Services.
• Provide effective communication for members, providers, and internal staff through various platforms such as clinical calls, coverage determination letters, and email.

Supporting Responsibilities:

• Act as backup for other team members and departmental functions.
• Provide accurate and timely drug coverage determinations for members of PacificSource Health Plans based on posted criteria, current standards of medical practice, and member-specific condition.
• Assist Medical Directors in reviewing appeals for denied coverage determinations.
• Represent Pharmacy Services Department, both internally and externally, as requested
• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: Minimum of 4 years of managed-care pharmacist work experience is required with demonstrated excellence in deliverables and successful collaboration. Additional experience managing complex work processes is highly preferred. Prior experience in healthcare integration, process development and program implementation is preferred.

Education, Certificates, Licenses: Doctor of Pharmacy degree or Registered Pharmacist, and valid state license without restriction required. Post-graduate training (examples include Residency, Fellowship, MBA, BCPS) is preferred. Additional certifications may be needed such state specific credentials.

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.

Competencies

Adaptability

Building Customer Loyalty

Building Strategic Work Relationships

Building Trust

Continuous Improvement

Contributing to Team Success

Planning and Organizing

Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required no more than approximately 5% of the time.

Skills:

Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Compensation Disclaimer

The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range.

Base Range:

$113,519.99 - $198,659.99

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.

• We are one team working toward a common goal.

• We are each responsible for customer service.

• We practice open communication at all levels of the company to foster individual, team and company growth.

• We actively participate in efforts to improve our many communities-internally and externally.

• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.

• We encourage creativity, innovation, and the pursuit of excellence.

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.

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.