Telecommute Option - MUST reside in ID, OR, UT or WA
The Manager, Clinical Pharmacy Services manages team of clinical pharmacists. Organizes, and oversees clinical pharmacy activities and services including services pertaining to: evidence reviews of medications, formulary development, Pharmacy and Therapeutics (P&T) Committee support, medication use policy development, Medication Policy Group (MPG), medication pipeline monitoring, medication trend management, and consultation and guidance on medication-related issues. The scope includes medications covered under the pharmacy benefit, medical benefit and specialty medications.
Normally to be proficient in the competencies listed below
The Manager, Clinical Pharmacy Services would have a Bachelor's degree in Pharmacy or Pharm.D.; Residency certificate or advanced degree in health care administration, economics, public health, pharmacy administration, finance, or equivalent field preferred; three years of experience in patient care setting as well as management or professional business experience in a managed health care system, medical group, hospital, or related business in health care delivery industry or an equivalent combination of education and experience.
Assures service levels and activities meet client service level agreements, as well as contractual obligations and compliance, such as state, federal, and CMS regulations or specific member contracts with service guarantees.
Provides clinical support in working both internally and across departmental teams (such as clinical, customer services, sales/marketing, operations, medical services, contracting/rebates, analytics) in assuring successful performance of pharmacy clinical and overall programs.
Develops goals and objectives, manages clinical staff (or indirect staff), and provides clinical support for pull-through pharmacy initiatives and programs.
Provides leadership in the area of specialty pharmacy management, including developing and maintaining the medication pipeline to inform utilization management strategies, and keeping key stakeholders apprised of high impact medication approvals.
Provides routine and/or intermittent reporting and analysis as appropriate of formulary and utilization management activities that fall under their oversight to assure quality and effective policies and programs.
Manages the day-to-day development and maintenance, and ensures quality of the Preferred Drug List (PDL). This includes product review; market analysis; writing, editing/revising and publishing the PDL; development of coverage guidelines and prior authorization (PA)/medication policy criteria.
Provides advice and direction to Pharmacy and Therapeutics (P&T) Committee, Medication Policy Group (MPG), and the Quality, Cost, and Utilization Review Team (Q-COURT) on efficacious and safe medication use.
Prioritizes the development of clinical topics for review by clinical pharmacy staff, the P&T committee, and the MPG. Ensures the appropriate documentation of clinical decision-making processes.
Provides leadership and mentorship to direct reports, including clinical and non-clinical staff, through development and tracking of performance goals and objectives, as well as through quarterly performance conversations. Prioritizes and manages work activities of clinical pharmacist consultant staff.
Creates, develops and supports medication use programs to encourage the use of best value medications, and discourage the use of unsafe medications or medications with very low clinical value for pharmacy benefit, medical benefit, and specialty medications.
Contributes to and supports the corporation's quality initiatives through process improvement teams and by encouraging team and individual contributions toward the corporation's quality improvement efforts.
Supports the PGY1 Managed Care Residency program.
Collaborates with the Pharmacy Directors, VPs, and other leadership in coordinating corporate-wide activities related to the appropriate use of medications, improved quality related to medication therapy, promotion of cost-effective prescribing, and reduction in short-term and long-term overall costs to internal and external clients.
Strong clinical pharmacy background with ability to demonstrate clinical therapy skills and knowledge.
Strong knowledge of health care economics and financing; health care industry dynamics; health plan and benefit design, and provider contracting strategies, techniques, and processes.
Demonstrated success in managing professional business relationships in a managed care system, medical group, hospital, or related business in health care delivery industry.
Excellent verbal and written communication skills; strong business analytical skills and abilities; project management and coordination ability; ability to function effectively as a management team member.
Ability to select, train and lead staff, manage resources and prioritize workload.
Demonstrated knowledge of: Medicare/CMS regulations and applicability in administering the Medicare Product; Pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; Health care coding and payment systems (such as ICD-9, CPT, HCPCS, NDC); Compliance related activities, legislative and regulatory activities; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA.
Required Licenses, Certifications, Registration, Etc.
Licensed pharmacist in state of practice.
Up to 10 direct reports
Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members for 100 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.
If you're seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers' engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.
This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards.
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.