Pharmacy Clinical Consultant

2 weeks ago

Renton, Washington, United States Cambia Health Solutions Full time
Pharmacy Clinical Consultant

Cambia Health Solutions is seeking a highly skilled Pharmacy Clinical Consultant to join our team. As a key member of our Health Service Organization, you will play a pivotal role in designing, implementing, and maintaining clinical programs and strategies that drive cost containment and clinical quality enhancements related to pharmacy services.

Key Responsibilities:

  • Lead the identification of clinical areas for product development and execute clinical programs to meet member needs.
  • Stay abreast of industry trends and market differentiating clinical strategies to maintain competitive knowledge.
  • Analyze utilization trends and quality outcomes, providing creative solutions to support cost containment, quality improvement, and regulatory compliance.
  • Evaluate and select vendor clinical offerings that align with Regence's clinical and business goals, and negotiate, monitor, and manage vendor performance.
  • Contribute to pharmacy clinical strategies, formulary development, policy development, benefit design, and utilization management initiatives.
  • Regularly assess and refine clinical product offerings to maintain a competitive portfolio with strong ROI, and design/improve clinical and operational processes to support exceptional member experiences and operational efficiency.
  • Provide consultative expertise to strategic partners, plan leadership, purchasers, and other stakeholders, and mentor/coach pharmacy students and residents as needed.

Requirements:

  • Bachelor's degree in a health-related field.
  • 4 years of experience in ambulatory care/hospital/pharmacy benefit management.
  • Pharm.D. degree and experience in pharmacy benefit management and clinical program development is preferred.
  • Must be an active and unrestricted licensed pharmacist in the state of practice.

Preferred Qualifications:

  • Possesses in-depth knowledge of the pharmacy benefit management industry, including benefit design, pharmacy products and services, and competitive offerings, as well as client needs.
  • Demonstrates strong understanding of healthcare economics and financing, industry dynamics, and pharmacy/provider service reimbursement of medications.
  • Exhibits strong clinical knowledge and understanding of evidence-based medicine principles, with the ability to apply them to formulary design, medication coverage policies, and other medication management solutions.
  • Proven ability to interpret complex clinical information, claims data, and regulatory requirements to develop practical and creative product development solutions.
  • Demonstrates leadership and interpersonal skills, with the ability to effectively manage projects and vendor relationships.
  • Possesses excellent verbal and written communication skills, strong business analytical skills, and project management and coordination abilities.
  • Proven success in managing professional business relationships in the healthcare delivery industry, including managed care systems, medical groups, and hospitals.
  • Familiarity with health plan and benefit design structures, Medicare/CMS regulations, and pharmaceutical products, including orals, injectables, infusion products, and chemotherapy.
  • Knowledge of healthcare coding and payment systems, such as ICD-10, CPT, HCPCS, and NDC.
  • Understanding of state and federal laws and rules regarding pharmacy practice and healthcare industry regulations, including DOLI, PPACA, and HIPAA.
  • Familiarity with compliance-related activities, legislative and regulatory activities, health insurance operations, and legal research is desirable.

About Cambia Health Solutions:

Cambia Health Solutions is a leading health solutions company that is dedicated to making healthcare easier and lives better. We are committed to creating a person-focused and economically sustainable healthcare system.

What We Offer:

Cambia Health Solutions offers a dynamic and supportive work environment, competitive compensation and benefits, and opportunities for professional growth and development.

How to Apply:

If you are a motivated and experienced pharmacy professional looking for a new challenge, please submit your application, including your resume and cover letter, to [insert contact information].

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