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.

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.

• 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.
• 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.
• 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.
• Conducts utilization management reviews and…