Looking for a way to make an impact and help people?
Join PacificSource and help our members access quality, affordable care!
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
The Clinical Pharmacist is responsible for participation in all day-to-day aspects of the Pharmacy Services Department, including but not limited to issuance of all pharmacy coverage decisions, development of policies and procedures and coordination of pharmacy benefits for members. Responsible for participation in the Pharmacy & Therapeutics (P&T) Committee including reviewing and presenting new drug reviews, drug class reviews, and policy reviews. Responsible for maintaining compliance with all state and federal legislation. Serve as a clinical resource person for Health Services staff, other internal associates, and external vendors as necessary.
Essential Responsibilities:
Provide drug coverage determinations for members with PacificSource Health Plans.
Provide effective communication for members, providers, and internal staff through various platforms such as clinical calls, coverage determination letters, and email.
Support clinical meetings with internal and external stake holders as requested.
Review prescription formularies and criteria for needed updates based on clinical guidelines.
Participate in P&T Committee meetings through review of new drugs, drug classes, and authorization policies with presentation of materials to staff members prior to meetings and to committee members during meetings.
Lead and / or assist in projects as assigned.
Stay up to date on State and Federal regulations as they relate to health insurance coverage.
Stay up to date on quality measures pertinent to Pharmacy Services.
Keep current with new and emerging clinical trends.
Supporting Responsibilities:
Act as backup for other team members and departmental functions.
Work with Clinical Pharmacy Manager and/or designee to improve processes, systems, reporting, and services provided by the department
Represent Pharmacy Services Department, both internally and externally, as requested.
Meet department and company performance and attendance expectations.
Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
Perform other duties as assigned.
SUCCESS PROFILE
Work Experience:
Three or more years of pharmacy related work-experience is preferred. Additional experience managing complex work processes and working as part of a multidisciplinary care team is highly preferred. Prior success in healthcare integration, process development and program implementation is desirable.
Education, Certificates, Licenses:
Required to be a registered pharmacist with either Pharm D degree or Bachelor of Science in Pharmacy. Additional certifications may be needed such state specific credentials. Certification support may be available for credentials needed post-hire. Post-graduate training (examples include Residency, Fellowship, MBA, BCPS) is preferred.
Knowledge:
Ability to adapt and prioritize within a fast-paced environment. High attention to detail. Knowledge and comprehension of pharmaceutical services, including federal and state statutes and regulations as they pertain to the insurance-related pharmacy services and benefits administration. Ability to assess pharmaceutical alternatives, treatment plans, drug technologies and new approaches to delivering pharmacy services. Strong verbal and written communication skills. Proficiency in Microsoft Office Suite. Ability to work independently and within groups with minimal supervision.
Competencies:
Adaptability
Building Customer Loyalty
Building Strategic Work Relationships
Building Trust
Continuous Improvement
Contributing to Team Success
Planning and Organizing
Work Standards
Environment:
Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.
Skills:
Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork
Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for customer service.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our many communities-internally and externally.
We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
We encourage creativity, innovation, and the pursuit of excellence.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
