Clinical Pharmacist II

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

As assigned, supports any of the following pharmacist specialty areas; formulary and policy development, intervention programs for commercial and Medicare programs, partnering with sales team, or health systems liaison. Develops and implements evidence based clinical programs to ensure that members receive the most clinically appropriate medication cost-effectively. Evaluates evidence and applies these principles to patient care.

• Based on assigned pharmacist specialty area, may include any of the following (% of time per function will vary):
• Develops policies and strategies to engage members and/or providers and help drive improvements in pharmaceutical care and pharmacy quality measures to decrease drug spend.
• Addresses Medicare STAR drugs (STATIN, RASA, and non-insulin diabetes) adherence gaps.
• Reviews drug/medical literature, clinical practice guidelines, quality measures, and available national guidelines to support formulary, drug policy or drug therapy interventions and creation of new initiatives.
• Interacts with PBM/vendor oversight activities including regular or ad-hoc audits of clinical programs.
• Develops and implements programs to communicate and educate internal staff, external brokers, strategic health systems, pharmacy chains and provider groups.
• Performs Consumer Assessment of Healthcare Providers and Systems (CAHPS)-focused interventions to improve drug plan perception.
• Promotes the value-add of the Company’s pharmacy services with internal and external stakeholders. Develops relationships and partnerships to support health systems engagement or sales efforts.
• Assists Sales in selling and renewing pharmacy services, or retaining business, by attending meetings, promoting pharmacy benefits and services, developing responses to Request for Proposal (RFP), recommending solutions to brokers and their clients, etc.
• Collaborates with pharmacy departments within the Company’s strategic health systems, pharmacy chains and provider groups to implement programs which better engage members to improve overall medication quality performance and cost of care for attributed populations by facilitating regular interactions to build and support the clinical relationship.
• Assists in closing Medicare STARS-related gaps by completing Comprehensive Medication Reviews (CMRs), Medication Reconciliation Post-Discharge (MRPs), and In-Home Assessments (IHAs).
• Partners with internal departments including Medicare STARS, Clinical Quality Health Services, Provider Network Management, HEDIS, and Customer Care to develop and implement programs and clinical initiatives to support achievement of strategic goals.
• May orient, train, and assist new hires, residents, and junior level Pharmacists. Maintains and shares clinical knowledge and knowledge of prescription benefit trends.
• Performs other duties as assigned.

• Doctor of Pharmacy (Pharm.
  
  D.) preferred. Bachelor of Pharmacy with relevant experience may be considered.
• 3 years of experience as a Clinical Pharmacist or equivalent experience in a managed care pharmacy setting.
• Medicare/Medicaid experience preferred.

• Registered Pharmacist with current unrestricted license from the appropriate State Board of Pharmacy.
• May be required to obtain Ohio State Board of Pharmacy license within 6 months of hire.

• Understanding of managed care pharmacy, including formulary design/management, drug utilization management, and/or quality assurance programs.
• Knowledge of medical/pharmacy terminology/coding and specialty drug management.
• Good clinical acumen and strategic analysis skills.
• Microsoft Office skills specifically Excel and Pharmacy Benefit…