Clinical Pharmacist Specialist, Denver Health Medical Plan
We are recruiting for a Clinical Pharmacist Specialist, Denver Health Medical Plan to join our team!We are here for lifes journey.
Where is your life journey taking you?Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all:
Humanity in action, Triumph in hardship, Transformation in health.
DepartmentManaged Care Administration Must be a Colorado ResidentJob SummaryTheClinical Pharmacist forManagedCarewillreport to andoperate under the direction of pharmacyleadershipandwill be expected to workcooperativelyandsometimesindependentlywith all medical directors,utilizationmanagementnurses,andhealthplanpersonnel to improve the overallhealthoutcomes of our members.
Theywillneed to perform prospective and/or retrospectivedrugutilizationreviewsandappeals per StateandFederalregulations,participate in the distribution of clinical drug information, and educateprovidersandstaffregarding the use of pharmaceutical treatment regimens or requirements.
They must also comply withallcompanystandardoperating procedures, policies,guidelines, and workinstructions.
In addition,participationinInterdisciplinaryCareTeam (ICT) meetings,MedicationTherapyManagement(MTM)efforts, and Pharmacy &TherapeuticsCommitteemay be asked of this role.
Essential Functions:
Uses clinicalknowledge and independent critical thinking skillstowardinterpretingcriteria, policies, and procedures to makedeterminations on prior approval reviews andretrospectivereviews or appeals.
Assist in the completion,development,andsupervision of support staff forthedrugutilizationand prior authorizationreviewprograms.
Identifies,develops,andmaintainsclinicalcriteriaforpriorauthorizationsand step therapy for designated lines of business.
Workwithpharmacyleadership to ensurecompliancewithStateandFederalpharmacyregulationsforMedicaid,Medicare, and Commercial Lines of business.
Develop,implement, and manage pharmacy cost containmentstrategies,including high-risk, high- cost, and high-usemedications, to determine the mostappropriate medication use managementstrategyforidentifiedmedications.
Evaluateandidentifyopportunitiesforimprovedmanagement of drug benefitsthroughclinicalresearchandanalytics that improvemedical/pharmacy cost savings and provideclinical quality initiatives.
Actively work to support thepreparationand delivery of reporting and meetingmaterials.
Serve as a liaison to individual pharmacists, pharmacies,internalcommittees, case management,medicalmanagement, and other providers on pharmacy issues.
Workwith the clinicalandoperations staff of allvendors of pharmacy programs, includingsupport to internaloperational departments on implementingvarious PBM programs.
Participate in the InterdisciplinaryCareTeam (ICT) meeting and collaborateswithComplexCaseManagement(CCM) and UtilizationManagement(UM) on care coordination for high-risk members.
Participationin Medication TherapyManagement(MTM)effortswhen required.
Participate in the activities of the Pharmacy &TherapeuticsCommittee, including clinical and financialreviews of individual drugs,drug classes, formularydevelopment,anddevelopment of clinical policiesandrelatedmetrics.
Education:
Bachelors Degree BPharm Required Doctorate Degree PharmD (preferred) Colorado Pharmacist License Required Work
Experience:
RPhorPharmDdegreewithatleast1-3yearsofpharmacy,managedcare,and/orpharmaceuticalindustryexperience.
Requiresafunctionallevelunderstandingofthepharmacyindustry,includinghealthplan/PBMrelationshipanddrugspaidforonthemedicalvs.
pharmacybenefit.
Licenses:
PHA-LicensedPharmacist-DORA-DepartmentofRegulatoryAgenciesKnowledge, Skills and Abilities:
Excellentverbalandwrittencommunicationskillswith the ability to communicateandcollaborateeffectivelywith all internalstakeholders.
Stronginterpersonal, consultation, organizational, tracking, and follow-upskills.
Data review andinterpretationskillsarepreferred to identifyandresolvedrug-relatedproblems and trends.
Ability to work as a teammember.
Strongorganizationalskillsandattention to detail.
Ability to instruct,direct, and evaluateemployees-will be required to assumeresponsibilityfor daily PA operations.
Ability to workindependently and withlittlesupervision.
Prior experienceand/orknowledge of processimprovementpractices Proficiencywith Epic, preferred but not required Proficiencywith MS Office,required.
ShiftDays (United States of America)Work TypeRegularSalary$125,900.
00 - $195,200.
00 / yrBenefits Competitive pay Outstanding benefits Education opportunities Shared leadership and advancement opportunity State-of-the-art facilities Immediate retirement plan matching Professional clinical advancement program Participation in evidence-based projects Public Service Loan Forgiveness (PSLF) eligible employer National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer Our Values Respect Belonging Accountability Transparency All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.
Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denvers 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.
As Colorados primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured.
Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.
Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).
Denver Health values the unique ideas, talents and contributions reflective of the needs of our community.
For read more about our commitment to diversity visit:
Recommended Skills Care Coordination Case Management Clinical Works Consulting Cost Reduction Critical Thinking Estimated Salary: $20 to $28 per hour based on qualifications.
Where is your life journey taking you?Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all:
Humanity in action, Triumph in hardship, Transformation in health.
DepartmentManaged Care Administration Must be a Colorado ResidentJob SummaryTheClinical Pharmacist forManagedCarewillreport to andoperate under the direction of pharmacyleadershipandwill be expected to workcooperativelyandsometimesindependentlywith all medical directors,utilizationmanagementnurses,andhealthplanpersonnel to improve the overallhealthoutcomes of our members.
Theywillneed to perform prospective and/or retrospectivedrugutilizationreviewsandappeals per StateandFederalregulations,participate in the distribution of clinical drug information, and educateprovidersandstaffregarding the use of pharmaceutical treatment regimens or requirements.
They must also comply withallcompanystandardoperating procedures, policies,guidelines, and workinstructions.
In addition,participationinInterdisciplinaryCareTeam (ICT) meetings,MedicationTherapyManagement(MTM)efforts, and Pharmacy &TherapeuticsCommitteemay be asked of this role.
Essential Functions:
Uses clinicalknowledge and independent critical thinking skillstowardinterpretingcriteria, policies, and procedures to makedeterminations on prior approval reviews andretrospectivereviews or appeals.
Assist in the completion,development,andsupervision of support staff forthedrugutilizationand prior authorizationreviewprograms.
Identifies,develops,andmaintainsclinicalcriteriaforpriorauthorizationsand step therapy for designated lines of business.
Workwithpharmacyleadership to ensurecompliancewithStateandFederalpharmacyregulationsforMedicaid,Medicare, and Commercial Lines of business.
Develop,implement, and manage pharmacy cost containmentstrategies,including high-risk, high- cost, and high-usemedications, to determine the mostappropriate medication use managementstrategyforidentifiedmedications.
Evaluateandidentifyopportunitiesforimprovedmanagement of drug benefitsthroughclinicalresearchandanalytics that improvemedical/pharmacy cost savings and provideclinical quality initiatives.
Actively work to support thepreparationand delivery of reporting and meetingmaterials.
Serve as a liaison to individual pharmacists, pharmacies,internalcommittees, case management,medicalmanagement, and other providers on pharmacy issues.
Workwith the clinicalandoperations staff of allvendors of pharmacy programs, includingsupport to internaloperational departments on implementingvarious PBM programs.
Participate in the InterdisciplinaryCareTeam (ICT) meeting and collaborateswithComplexCaseManagement(CCM) and UtilizationManagement(UM) on care coordination for high-risk members.
Participationin Medication TherapyManagement(MTM)effortswhen required.
Participate in the activities of the Pharmacy &TherapeuticsCommittee, including clinical and financialreviews of individual drugs,drug classes, formularydevelopment,anddevelopment of clinical policiesandrelatedmetrics.
Education:
Bachelors Degree BPharm Required Doctorate Degree PharmD (preferred) Colorado Pharmacist License Required Work
Experience:
RPhorPharmDdegreewithatleast1-3yearsofpharmacy,managedcare,and/orpharmaceuticalindustryexperience.
Requiresafunctionallevelunderstandingofthepharmacyindustry,includinghealthplan/PBMrelationshipanddrugspaidforonthemedicalvs.
pharmacybenefit.
Licenses:
PHA-LicensedPharmacist-DORA-DepartmentofRegulatoryAgenciesKnowledge, Skills and Abilities:
Excellentverbalandwrittencommunicationskillswith the ability to communicateandcollaborateeffectivelywith all internalstakeholders.
Stronginterpersonal, consultation, organizational, tracking, and follow-upskills.
Data review andinterpretationskillsarepreferred to identifyandresolvedrug-relatedproblems and trends.
Ability to work as a teammember.
Strongorganizationalskillsandattention to detail.
Ability to instruct,direct, and evaluateemployees-will be required to assumeresponsibilityfor daily PA operations.
Ability to workindependently and withlittlesupervision.
Prior experienceand/orknowledge of processimprovementpractices Proficiencywith Epic, preferred but not required Proficiencywith MS Office,required.
ShiftDays (United States of America)Work TypeRegularSalary$125,900.
00 - $195,200.
00 / yrBenefits Competitive pay Outstanding benefits Education opportunities Shared leadership and advancement opportunity State-of-the-art facilities Immediate retirement plan matching Professional clinical advancement program Participation in evidence-based projects Public Service Loan Forgiveness (PSLF) eligible employer National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer Our Values Respect Belonging Accountability Transparency All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.
Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denvers 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.
As Colorados primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured.
Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.
Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).
Denver Health values the unique ideas, talents and contributions reflective of the needs of our community.
For read more about our commitment to diversity visit:
Recommended Skills Care Coordination Case Management Clinical Works Consulting Cost Reduction Critical Thinking Estimated Salary: $20 to $28 per hour based on qualifications.
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