Clinical Pharmacist Specialist II

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Join Pacific Source and help our members access quality, affordable care!

Pacific Source 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. Pacific Source 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 Pacific Source’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 work streams. 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.

• 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.

• Act as backup for other team members and departmental functions.
• Provide accurate and timely drug coverage determinations for members of Pacific Source 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 Pacific Source privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

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.

Building Customer Loyalty

Building Strategic Work Relationships

Building Trust

Contributing to Team Success

Planning and Organizing

Work Standards

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

Accountability, Collaboration, Communication…