Population Health Clinical Pharmacist

Primary City/State:

Phoenix, Arizona

Department Name:

Pharm Benefits Mgmt-Misc

Work Shift:

Day

Job Category:

Pharmacy

Pharmacy careers are better at Banner Health. We are committed to developing the careers of our team members. We care about you, your career today and your future. If you’re looking to leverage your abilities – apply today. 

As a Population Health Clinical Pharmacist, you will use clinical knowledge to review medication prior authorization requests against set clinical criteria. You will also review chart notes and labs from providers to ensure criteria have been met or should be denied. You'll be expected to select appropriate letter and/or fax template to notify providers/members of decision and/or request additional information and you must document all decisions following standard template. You may interact with providers (and rarely members) for additional information and/or to provide education about criteria

This is a hybrid, work from home position with a schedule of Monday - Friday 8AM - 5PM (AZ time zone.) On call, weekend, and holiday rotations required.

Banner Pharmacy Services is a recognized leader in healthcare and trusted partner in proactively providing innovative pharmacy services through excellence in integration, care coordination, medication management and services to make a difference in people's lives. Clinical Pharmacy Services is responsible for the management of the Banner formulary, development of standardized system wide clinical pharmacy services, and management of adverse drug event preventions. Clinical Pharmacy Services provides collaborative drug therapy management and educational interventions in patient care to optimize medication therapy, improve outcomes, promote wellness, and disease prevention. As a division, Banner Pharmacy services provides excellent patient care across our entire continuum through convenient access, improved medication outcomes and innovative pharmacy practices.

POSITION SUMMARY
This position supports all aspects of pharmacy services within the Banner Health Insurance Division, including utilization management, care management, and pharmacy quality responsibilities. This position drives optimal member experience, provider experience, and financial performance through assigned areas of work. Incumbents maintain a high degree of clinical acumen, and leverages strong organizational, communication, and execution skills to ensure the successful deployment of pharmacy benefits across all populations. This role is highly independent, and incumbents work across departments, and with internal and external stakeholders.

CORE FUNCTIONS
1. Provides management of pharmacy services to Insurance Division members, including commercial, Medicare, Medicaid populations within owned/operated health plans as well as value-based agreements. Identifies and stratifies members based on complex pharmaceutical care needs to optimize pharmacotherapy regimens at the patient/member level, and population level to improve overall healthcare quality and reduce costs that is consistent with acceptable standards of pharmacy practice and CMS Medicare Part D regulations and guidance. Analyzes and interprets pharmacy and medical claims reporting and other sources of clinical and economic data to generate insights and clinical service opportunities.

2. Active participant and/or leader in defining, implementing, and managing clinical programs and services that improve pharmaceutical care quality and lowers costs in all Insurance Division lines of business. Programs include but are not limited to, medication therapy management, pharmacy quality measure performance, utilization management, member outreach and engagement, provider education and detailing, drug utilization reviews, or formulary monograph development.

3. Maintains proficiency in all legal, regulatory, and practice standards related to CMS, AHCCCS, or out-of-state Medicaid programs. Maintains proficiency in all pharmacy related URAC, NCQA, or other applicable accreditation standards. Maintains clinical proficiency in assigned clinical area(s) through continuing education.

4. Conducts utilization management reviews and adjudicates prior authorization requests and appeals. Participates in multidisciplinary appeals and grievances reviews as assigned. Takes ownership to identify and resolve utilization management issues and promotes a best-in-class member and provider experience and optimal clinical outcomes for the member. 

5. Communicates with and supports Insurance Division members and network providers and support staff, Health Plan leaders, and Insurance Division executives concerning pharmacy issues and programs and services. Works closely with pharmacist and pharmacy technician team members to contribute to a high-performing team.

6. Applies the principles of continuous quality improvement consistent with job expectations. Incorporates quality improvement principles into other activities and projects (i.e. data collection, documentation).

7. May be assigned to collaborate with technical experts to create data extracts of pharmacy, eligibility, provider, or medical claims data for health plan pharmacy utilization management and audit functions.

8. Participates in student and resident learning experiences, including as primary and supportive preceptor as assigned.

MINIMUM QUALIFICATIONS

Must possess a degree in Pharmacy (advanced degree preferred) from an accredited College of Pharmacy.

Completion of an accredited PGY1 pharmacy residency program or three years of previous clinical pharmacy experience in the managed care, community pharmacy, or ambulatory care setting.

Requires current and unrestricted pharmacy licensure in the applicable state of practice within 90 days of hire date.

Incumbents in Arizona are also required to provide the AZ Board of Pharmacy Wallet Card at time of hire.

Requires a proficiency level in managed care/health plan or pharmacy benefits experience typically obtained in 2 years. Requires effective human relations and verbal/written communication skills and the ability to work collaboratively with community-based practitioners and the senior population is essential. An understanding of the interrelationships of health plan pharmacy components, members, and providers is required.

Proficiency with PC based productivity tools (e.g. spreadsheets, word processing, e-mail) required. Needs analytical ability to support decision making; organizational ability to manage multiple tasks and projects by established deadlines.

PREFERRED QUALIFICATIONS
 

Geriatric certification is a plus; experience with Medicare Part D is a plus.

Additional related education and/or experience preferred.

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EEO/Disabled/Veterans

Our organization supports a drug-free work environment.

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