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Pharmacist License Required for WA, OR, or CA. 3+ Years in a Managed Care Environment Required (meaning dealing with Prior Authorizations, Audits, Appeals, ALJ Court hearings, etc). Rare weekends required a few times per year. Managed Care Pharmacist The Clinical Pharmacist Specialist (CPS) is responsible for the effective provision of clinical pharmacy services to members of Providence Health Plan (PHP). The CPS will collaborate with medical directors, nurse case managers, and network physicians and other providers to provide coordinated, high quality and evidenced-based, cost-effective care to PHP members. The responsibilities of the CPS predominantly fall into the following areas: direct patient care through Medication Therapy Management (MTM) program, population-based disease management, specialty pharmaceutical acquisition and care coordination, drug utilization review and program development, clinical policy development and application, including Pharmacy and Therapeutics (P&T) Committee participation.

The CPS is skilled at reviewing pharmacy and medical claims; interacting with, assessing and providing education to members and caregivers; developing medication-related problem lists; and implementing medication action plans including interventions with health care providers. Education and consultation with physicians, pharmacists, nurses, and other members of the health care team, both internally and externally, will be required. Drug utilization work and medical policy activities will include developing and applying drug medical policies to influence safe, quality, and cost-effective use of prescription pharmaceuticals.

Duties include: communicating therapeutic recommendations to physicians effectively and tactfully, maintaining professional development and ongoing education in clinical pharmacy services, using time wisely and appropriately prioritizing multiple responsibilities, enhancing quality of care and optimizing outcomes while managing costs effectively.

Patient Population Served: Neonate, Pediatric, Adolescent, Adult, Geriatric. The treatment of patients should be individualized and should reflect an understanding of the developmental needs and range of treatment needs for each patient.

Coordinates and provides comprehensive clinical pharmacy services to patients receiving medication therapy management, including assessment and identification of medication-related problems, development and execution of a patient-specific medication-related action plan, collaboration with member's providers, effective communication of clinical pharmacy functions to multidisciplinary team members, participation in educational activities, drug utilization management functions, serving as a resource person to physicians and nurses, participation in meetings and committees, coordination of ongoing quality assurance evaluations, participation in educational activities including patient education, provider and staff presentations, newsletters and evidence-based literate reviews, participation in the Ambulatory Pharmacy and Therapeutics Committee and other department and Health Plan committees, serving as a resource to medical directors, nurses, and pharmacists, active participation in the education and training of pharmacists, interns, and PGY-1/PGY-2 residents, participation in rotation of departmental responsibilities, participation in the presentation of research findings, professional meetings, professional publications, or other scholarly activities, support the continuing improvement of clinical pharmacy practices through improvement of their own practice by actively participating in the educational and/or regular meetings of the local, state, or national hospital pharmacy organizations.

Education: PHARMD REQUIRED REQUIRED PGY-1 Residency training with 1 year of experience within relevant practice setting Preferred: Completion of specialty/PGY-2 Residency. Bachelors or MS Degree in pharmacy considered with 5 or more years of managed care experience with documented responsibility for evidence and clinical case review and direct consultation of medication information with physicians and/or patients. PGY-1 Managed Care Residency with PHP OR 3 years' experience as a clinical pharmacist in managed care.

Experience Required: Experience in writing, including research protocols, medical papers for publication, and educational pieces for patients and healthcare providers. Experience reviewing medication evidence and clinical policy development. Experience working in programs and services that support population health management. Experience and expertise working with a pharmacy claims processing platform.

Job Specific Knowledge, Skills & Abilities: Expert ability to provide clinical pharmacy services to generate medication-related problem lists and formulate a medication-related action plans for specific members. Expert knowledge of pharmaceutical products, clinical pharmacology & therapeutics, and medical/pharmacy literature evaluation. General knowledge of pharmaceutical benefits. Expert knowledge of role of pharmacist in disease management and case management – especially as it relates to identifying those aspects that require pharmacist expertise, assessment, and collaboration with case managers and physicians. Ability to make formal and informal presentations to physicians, medical groups, pharmacists, nurses and other health care workers. Excellent verbal & written communication skills. Ability to translate & present complex pharmaceutical information as usable information for clinicians and members. Ability to develop and retrieve pharmaceutical information as it relates to benefits, diagnosis, condition, procedures, and billings. Ability to make formal and informal presentations to employers, benefit consultants, and regulators regarding pharmacy benefit management and patient care optimization using pharmaceuticals. Ability to work with data analysts to develop monitoring and reporting tools that are effective in both identifying patients who need pharmacy services and reporting outcomes to end-users and physician caregivers. Strong patient safety, outcomes and quality of care advocate who recognizes the role of fiscal responsibility in health care delivery is desired for this unique clinical pharmacist position. Drug information expert who can provide information to all types of learners and in a variety of direct, telephonic, and electronic means. Comprehensive clinical pharmacy knowledge base. Advanced knowledge of the principles of evidence-based medicine. LIC Required: Oregon.