Clinical Pharmacist
3 days ago
Fort Lauderdale
Job Description Position Summary: The Clinical Pharmacist will conduct research and maintain or enhance clinical pharmacy programs such as drug utilization review, health outcomes, disease state management, care management, and other specialty programs. The Clinical Pharmacist will work to drive pharmacy initiatives and clinical programs for all lines of business. The clinical pharmacist will research, develop, and update drug utilization management strategies and work to promote clinically appropriate prescribing practices which adhere to applicable formulary, regulatory guidelines, and national clinical practice guidelines. The Clinical Pharmacist will interact frequently and independently with Plan members, prescribers, pharmacies, collaborative care team members, and with the PBMs. Essential Duties and Responsibilities: Key Responsibilities: • Clinical Pharmacy Services:, • Provide patient care services to all enrollees (Managed Medical Assistance (MMA), Florida Healthy Kids (FHK), Serious Mental Illness (SMI) & 22Health (Marketplace)) by conducting medication therapy management (MTM) reviews, providing medication counseling, or conducting PA audits., • Customer relationship management (CRM’s). Research and resolve enrollee or provider related concerns in a timely manner. Provide professional succinct documentation in designated medical systems., • Conduct comprehensive medication reconciliation reviews to identify and resolve drug-related problems for SMI members experiencing transitions of care (TOC). Monitor for TOC of members assigned to current partners in care., • Collaborate with internal and external partners in care (PBM’s) on various pharmacy and quality related concerns., • Develop or contribute to the development of new pharmacy-related clinical services and the creation of standard operation procedures (SOP’s) as needed., • Assist with State related allegations, G&A services, UM (PA, retro reviews) services and medical J-code reviews as needed for various lines of business., • Medication Management:, • Monitor patient medication regimens for efficacy, safety, cost, and adherence., • Conduct daily MTM outreach calls and HEDIS program calls to assist members with medication-related education and needs., • Monitor clinical program completions with appropriate follow up as needed to verify the goal of the call was accomplished., • Ensure appropriate use of chronic medications and follow up appointments with emphasis on psychotropic medications when encountered (SMI and others), considering patient-specific factors and clinical guidelines., • Complete assigned PBM PA audits in a timely matter as assigned., • Understand and implement the formularies for the various lines of businesses, and ensuring appropriate utilization of the formularies as needed. Provide formulary substitution options, as needed when checking PA request., • Collaboration and Consultation:, • Work closely with peers and CCP clinical teams (medical director, social workers, and other healthcare professionals) to coordinate care within CCP or with external partners., • Provide expert consultation on medications during clinical calls as needed. Example: monthly calls with the Foundation of Sickle Cell Disease and Research (FSCDR)., • Participate in multidisciplinary team meetings and case conferences as needed., • Participate in the grievances and appeals process. Review cases and attend hearings to participate in the discussions as needed. Assist with prescriber consultations related to denied medication facing an Appeal to potentially resolve before the hearing., • Work with PBM teams to address member needs and departmental needs., • Assist with PBM oversight related activities as needed., • Patient Education and Support:, • Educate patients and caregivers on medication regimens, potential side effects, and the importance of adherence., • Address patient concerns and questions regarding their medications and treatment plans., • Provide resources and support for patients to manage their conditions effectively., • Precept and assist with coordination of the CCP pharmacy residency program., • Educate providers and members about the formulary specific to their line of business., • Support pharmacy staff in all departmental endeavors as needed., • Quality Improvement:, • Participate in quality improvement initiatives related to the National Committee for Quality Assurance (NCQA), Accreditation Association of Ambulatory Health Care (AAAHC) and the American Association of Health-System Pharmacist (ASHP)., • Contribute to the development and implementation of clinical programs related to the improvement of the Healthcare Effectiveness Data and Information Set (HEDIS) outcomes., • Contribute to the coordination and management of the Marketplace population 22 Health., • Assist in the development and enhancements of the CCP pharmacy residency program., • Collaborate with pharmacy team members on quality improvement strategies. 6. Regulatory Compliance: • Ensure compliance with state and federal regulations related to the prescribing and dispensing of medications to FHK, Medicaid populations, and Marketplace., • Participate in the preparation for audits and inspections to ensure adherence to regulatory standards., • Report suspected fraud, waste and abuse violations of State policies governing CCP lines of business to the CCP Compliance and Privacy team. This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management. Qualifications: • Doctor of Pharmacy (PharmD) degree from an accredited institution., • Current, valid, and unrestricted pharmacist license in the State of Florida., • ASHP accredited residency trained or Board Certification in Pharmacy Services (BCPS). (preferred), • Must be motivated to serve this population and assist in effective problem solving., • Must have current knowledge and expertise in clinical pharmacology and disease state management., • Minimum of 3 years of experience in clinical pharmacy practice at a managed care organization or hospital. (preferred), • Comfortable with medication counseling as it relates to providers and plan enrollees, • Certified in medication therapy management (MTM) (preferred), • Ability to work effectively in a multidisciplinary team environment., • Proficiency in Microsoft 365 Office., • Experience working with Medicaid, FHK and ACA Marketplace plans. Skills and Abilities: • Ability to provide guidance, direction, and support to the pharmacy technician., • Facilitate communication and collaboration amongst internal and external team members., • Resolving conflicts and addressing challenges as they arise., • Excellent oral and written communication skills., • Ability to work flexible work hours., • Ability to travel to attend meetings as needed., • Manage multiple, concurrent projects for completion in a thorough and timely fashion., • Analyze data and formulate conclusions and recommendations., • Educate and influence groups and individuals to alter behaviors in accordance with company program goals and objectives. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic, travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion. Background Screening Notice: In compliance with Florida law, candidates selected for this position must complete a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse. The Clearinghouse is a statewide system managed by the Agency for Health Care Administration (AHCA) and is designed to help protect children, seniors, and other vulnerable populations while streamlining the screening process for employers and applicants. 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