Pharmacy Clinical Consultant
3 weeks ago
Cambia Health is seeking a highly skilled Pharmacy Clinical Consultant to join our team. As a key member of our Health Service Organization, you will be responsible for 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.
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.
Skills and Attributes:
- 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.
What You Will Do At Cambia:
- Lead the identification of clinical areas for product development and execute clinical programs to meet member needs, including pilots with strategic partners.
- 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.
Salary: The expected hiring range for a Pharmacy Clinical Consultant is $119,900 - $162,200 depending on skills, experience, education, and training; relevant licensure / c
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