Our established Medical Management Company is built on more than 100 years of collective experience in the managed care (healthcare) industry. We specialize in managing independent groups of physicians with both commercial and senior managed care (HMO) patients.
We are looking for a super star candidate as our on site, part-time Pharmacist, to establish and maintain strong working relationships with IPA providers. Promote the MSO and IPA missions, visions and values. Actively promote quality, efficient, humane, timely and cost-effective care and services to IPA patients as it pertains to medication treatment. Define quality and utilization goals, and initiate and lead quality improvement projects. Provide active pharmaceutical leadership to support quality improvement, utilization management and credentialing activities. Support IPA administrators in contracting, cost management, customer satisfaction and other management and service related issues as they pertain to medications/pharmaceuticals. Evaluate IPA provider performance based on objective outcomes, and provide feedback to individual providers so that they modify ineffective practices, improve services, maintain patient access and address clinical performance issues as needed. Promote and provide opportunities to IPA providers for education in pharmaceutical care treatment options.
· Must maintain a current California pharmacist license without restrictions.
· Must maintain professional liability insurance coverage.
· Must have extensive knowledge of managed care, including utilization and case management and quality processes.
· Must act in a professional manner when interacting with providers, staff and the public.
· Must maintain high quality medical care standard.
· Must be in good standing with the California State Board of Pharmacy.
· Attend required meetings and in the event of an anticipated absence, send a representative.
· Assist in preparation of meeting agendas that include instructive cases and educational elements.
· Work to improve IPA provider knowledge base and provide instruction to elevate care and service performance of IPA providers.
· Implement utilization management and quality improvement programs, and monitor assurance of compliance with contracted health plans and regulatory agencies.
· Monitor IPA provider practice patterns for under and over utilization of medication treatments.
· Maintain direct involvement in the management of high cost medication treatments.
· Handle referral requests timely, and ensure medical decisions are based on objective clinical effectiveness and evidence-based considerations.
· Provide IPA administrators and case managers with timely interpretation of pharmaceutical benefits, and render recommendations as needed.
· Review, recommend and support denials of service and payment when appropriate, and ensure decisions are based on contemporary evidence-based references.
· Actively review technology assessments regarding experimental and/or clinical drug trials and therapeutics with health plans.
· Be familiar with health plan bulletins and policy statements of coverage, and be able to access other medical reference sources.
· Monitor, evaluate and manage pharmacy utilization and costs, and use these results to educate and actively engage IPA providers to achieve clinically effective and cost effective outcomes.
· Actively participate in planning and implementation of risk management activities.
· Work closely with IPA quality improvement and utilization management departments to identify risk exposures and rectify them, and actively participate in corrective actions and interventions as required.
· Understand and facilitate network compliance with health plan and regulatory criterion and standards, including but not limited to NCQA, CMS and DMHC. Be familiar with new applicable regulations and laws, and lead modification of IPA practices to comply with new regulations and laws as needed.
· Define and implement evidence-based practice guidelines, monitor their effectiveness and provide objective feedback and guidance to IPA providers in regard to medication treatment plans.
· Assist IPA case managers and nurse practitioners with medication adherence and medication reconciliation as needed.
· Provide appropriate and effective directives for IPA providers to achieve optimal outcomes and benchmarks.
· Attend primary care physician meetings, as needed, to educate, inform and resolve primary care issues in regard to medication treatment plans.
· Represent the MSO at external/internal meetings to enhance delivery of care, utilization management and quality of care issues.
· Help market the MSO and its IPAs.
Our leadership operates within the highest level of integrity and respect, empowering staff with a strong support system. We are offering a solid opportunity with a growing company.
If you consider yourself a qualified, stellar candidate driven to demonstrate your initiative and reliability, please submit your resume with "Pharmacist” as the subject
Job Type: Part-time
The majority of our staff is working remotely due to Covid-19. This position will be performed ON-SITE for training and "as needed" until Covid restrictions are lifted, but candidate must know on-site work is essential job function.
Why Work Here?We specialize in managing independent groups of physicians with both commercial and senior managed care (HMO) patients. Our company is built on more than 100 years of collective experience in the managed care (healthcare) industry providing personalized care and exceptional service.
Room for Growth; Excellent leadership team;