Job Summary: Provides clinical pharmacy support services in order to ensure optimal medication management, improve health outcomes and quality of care for members. Advocates for customer medication needs by serving as a clinical leader within specialty provider networks, such as the Optimum Physician Alliance (OPA) management team.
Specific Job Accountabilities:
Serves as an advocate and liaison between members and HealthNow to address customer medication needs. Assesses, coordinates, monitors and evaluates options and services to ensure optimal medication management, improved health outcomes and quality of care for members.
Applies clinical understanding of medical diagnosis (es), and the appropriate pharmaceutical management of that diagnosis (es), in order to develop a treatment plan in conjunction with the member’s physician(s) and other pertinent allied health professionals.
Establishes strong and effective working relationships with OPA network practices. Analyses data and identifies gaps in service, while working with the OPA team to provide solutions.
Designs and interprets network partner utilization reports. Provides recommendations in order to maximize the value of the members’ pharmacy benefit. Identifies unmet clinical needs and develops effective solutions.
Works collaboratively with physicians, providers, co-workers and other internal departments in carrying out the established plan of care, and to ensure that OPA service level standards and clinical needs are met.
Researches and applies current medical and pharmacy literature when developing care plans. Provides clear written and verbal communications to providers and members.
Works with internal customers to provide appropriate drug information and medication recommendations. Assists other internal departments by responding to practice requests.
Demonstrates a thorough understanding of and applies the principles/standards of URAC and NCQA, Medical Services initiatives, and Strategic Business Unit goals.
Extensive knowledge of Medicare Part B (DME), Part D, Part C, Medigap policies and regulations, and Manufacturer Assistance programs.
Understanding of health care industry and a comprehensive knowledge of managed care concepts, especially related to HEDIS, NCQA and regulatory reporting.
Ability to interact with a cross-functional set of internal stakeholders to include physicians and providers, internal departments, clients and families.
Ability to listen with empathy to customers (external and internal) and give high priority to customer satisfaction.
Strong organizational skills and attention to details;
Excellent verbal and written communication skills, including by phone, email, and clinical documentation;
Ability to work in a fast-paced, collaborative environment with limited supervision.
Working knowledge of Microsoft Office applications with intermediate proficiency.
Valid driver’s license and acceptable driving history required due to travel involved with this position (DMV check will be conducted to review candidate’s driving record).
Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required.
Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc)
Required Education: BS Pharm or PharmD, with professional licensure (RPh)
Required Experience: Minimum three (3) years of experience working in a clinical pharmacy setting.
License/Certification: Current NYS licensure as a Pharmacist
- Must be able to work in an office environment
- Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks
- Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc)
- PPD Skin Test may be required by healthcare facility for onsite facility work
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