3 - Bachelor's Degree
2 -4 years of experience
The Clinical Pharmacy Analyst supervises the answering or directing internal questions related to pharmacy and following through to resolution. The Clinical Pharmacy Analyst monitors all PACE site Medication Lists for compliance to standard list and expiration and lot# tracking, as well as liaison to group purchasing organization for vendor contract compliance. The Clinical Pharmacy Analyst supervises the generating, printing, distributing and or emailing various reports to the Clinical Pharmacy Management team and other programs as indicated and needed. The Clinical Pharmacy Analyst is responsible for analyzing data from various reports and trending monthly as well as annually in Excel and or Clinical Documentation program. The Clinical Pharmacy Analyst also provides a customer service role by interacting with patients. The Clinical Pharmacy Analyst will perform additional functions as needed to for the operations of the Clinical Pharmacy Management department.
- Internal Customer Service, facilitate to resolution questions related to Clinical Pharmacy.
Pharmacy Benefit Management (PBM) questions forward to account team
Medication Over-rides (Refill-too-soon), lost medications, travel out of region, transition to community over-rides.
Answer Formulary questions
Generate Member claims history for suspected FWA
Medication data verification
- Member Customer Service.: follow-up with assistance services and outcomes with member.
- Work with Retail pharmacy and community pharmacists in facilitating services to patient e.g. obtaining pt. info etc. for PA initiation and completion, supporting physicians with information, and establishing communication and relationships/ support with community pharmacists
- Supervise and track the schedule for all department reports. Distribute various PBM and other reports for Clinical Pharmacy Management Program to all team members, analyze and trend data monthly (YTD) and annually, (year to year).
Quarterly Report: Coverage Review Determination Requests (sorted: approved and denied by plan and prescriber)
Quarterly Report: High Risk Medications by plan
Quarterly High Utilization Report Physicians, Pharmacies, Narcotics, sorted by region/member zip-code. Distribute to IDT and Palliative care Director
Quarterly MTM Eligible’s for Direct plan (member names); distribute to Direct Program Director.
Quarterly MTM CMR’s completed YTD for Direct; distribute to Direct Program Director. ( Access and target 10% of eligible for CMR completion. Supervise coordination of e CMR between PBM and Nurse Practitioner’s (NP) of Direct plan.
Quarterly Multi-Source Brand Use by plan: 3816, 1300, 3910
Quarterly Concurrent Drug Utilization Review (CDUR) for each plan and aggregate
Quarterly Retrospective Drug Utilization Review (RDUR) for each plan and aggregate
Monthly MTM eligible’s for PACE
Monthly Management Level Reports by plan:
PMPM drug cost
Top 25 drugs by cost
Top 25 drugs by volume
(Trend YTD within a given year, trend year to year)
Outliers, delve deeper to drug, member and physician level
Other Reports as needed
Monthly/ Quarterly compilation and analysis of Outlier reports on Prior authorization cases resulting in medication dispensing delays
- Coordinating with the PACE sites, monthly obtain and review Medication List (expirations, quantity) for compliance to standard list. Coordinate with Quality department, monthly review PACE site drug inspection reports
Liaison to all PACE sites
Facilitate resolution of drug recalls and backorders
- Review of Floor stock utilization by PACE SITE, assessment of cost per center, identify trigger / high cost drug use/ high risk drugs being stocked inappropriately
- Access E-Prescribing for multiple prescriber and multiple pharmacy PDE’s and report findings to IDT
- Request purchase history reports quarterly from Henry Schein or other vendor
Prepare report on all variances from PACE site approved medication list
Liaison to Innovatix/Essensa, send purchase history reports for contract compliance analysis
- Beacon PDIP reports, analyze, trend, distribute to clinical pharmacists
- Part D vaccine data analyze annual usage and prepare report for annual part D bid.
- Clinical documentation System Reports, (varied)
Develop templates as requested, such as letters and update provider contact files and other files as needed
Trend YTD by category of recommendation made to physician.
Trend YTD patient counseling sessions.
(Also trend year to year)
- Organize and print all reports for quarterly meetings.
- Liaison to St. John’s University College of Pharmacy: facilitate obtaining credentials, health screening, and scheduling experiential program participants
- Monitor Diabetic Supply use
- Distribute Narcotic Drug Utilization Review (DUR) data from PBM to clinical team and maintain case study management files for easy irretrievability. Review, analyze and identify trends, communicate to clinical team.
- Adheres to all Human Resources (HR) and Staff Development policies and procedures, including facility and department orientation and mandatory training and education.
- Relates to and communicates effectively with peers, staff, residents/patients, and families.
- Incorporates a customer service approach to problem solving and all operations.
- Assists Clinical Pharmacy Management team in maintaining Performance Improvement (PI) program and supports facility and corporate PI initiatives.
- Generates other reports as needed
- Member of committees as assigned
- performs other related duties as required.
Education: Degree in analytics or equivalent. Pharmacy operations experience a plus
Specialized Skills and Competencies:
- Demonstrates knowledge in the field of pharmacy
- demonstrates excellent written and oral communication skills.
- Expert level proficiency with Microsoft Applications: Excel, Word, and Outlook,
- Demonstrated proficiency with the statistical reporting of data and the ability to analyze, draw conclusions, and make recommendations from qualitative and quantitative information and data.
- Self-motivated, with demonstrated ability to work independently with minimal supervision
- Demonstrated energy, enthusiasm and self-motivation.
- Ability to communicate clearly and effectively, both verbally and in writing
- Assertiveness and the ability to work with limited guidance
- High level of integrity as demonstrated by 1) appropriate treatment of confidential information, 2) adherence to policies, procedures, rules and regulations, 3) professional conduct in dealing with persons internal and external to the organization and 4) sensitivity towards target population
Experience: Pharmacy experience preferred. Expert level proficiency with Microsoft applications.