Clinical Pharmacist Consultant

Work from home within Oregon, Washington, Idaho or Utah.

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Every day, Cambia’s dedicated team of Clinical Pharmacist Consultants are living our mission to make health care easier and lives better. As a member of the Pharmacy Services team, our Clinical Pharmacist Consultant provides professional and clinical pharmacy expertise in making or guiding clinical decisions based on best practices by applying evidence-based medicine evaluations to determine the best quality medication choices that represent the best value in efficacy, safety and affordability.

This may include providing coverage recommendations for medications subject to prior authorization, appeals, retrospective claim reviews, and audits based on applicable medication coverage policies, member benefit contracts, and provider contracts or serving as a resource for other staff, such as medical directors or case managers, regarding clinical, policy and benefit questions and interventions. May also provide direct outreach to members and providers around current and future clinical programs that would benefit them.

This role may also assist in planning, developing, and implementing clinical strategies with respect to formulary management, drug utilization management, medication therapy management programs, quality initiatives, gaps in care, peer to peer conversations and drug information and education and/or integrated pharmacy and case management strategies. Advanced responsibilities may include analyzing health care cost information, development of position papers, medication coverage policies, formulary monographs and class reviews, cross-functional projects, and/or initiatives related to the provision of pharmacy benefits that impact safety, quality and affordability – all in service of making our members’ health journeys easier.

• Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD) or related field
• 3-5 years of experience in clinical acute care/hospital setting or equivalent combination of education and experience
• Pharmacy license. Successful completion of a pharmacy residency or advanced degree in health‑related field preferred. Must be an active and unrestricted licensed pharmacist in state of practice

• Clinical pharmacy background with ability to demonstrate clinical therapy skills and knowledge in a clinical care setting.
• Demonstrated success in managing professional relationships in a managed care system, medical group, hospital, or related organizations.
• Excellent verbal and written communication skills; strong business analytical skills and abilities; strong project management and coordination ability.
• Knowledge of pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA.
• Strong clinical pharmacy background with ability to demonstrate clinical therapy skills and knowledge in a clinical care setting.
• Strong knowledge of health care economics and financing; health care/pharmaceutical industry dynamics; and pharmacy/provider service reimbursement of medications.
• Knowledge of Health Plan and benefit design structures and application;
  Medicare/CMS regulations and applicability in administering the Medicare Product; health care coding and payment systems (such as ICD‑9, CPT, HCPCS, NDC).
• Strong knowledge of compliance related activities, legislative and regulatory activities, health insurance operations, and legal issues.
• Ability to collaborate as part of cross functional teams, to improve clinical programs, enhance processes and share clinical information.
• Ability to work independently, to prioritize work, meet deadlines and achieve operational goals
• Experience with AI tools and technologies to enhance productivity and decision‑making in professional settings highly desired

• Deliver high‑quality pharmacy clinical services by applying evidence‑based medicine to…