Pharmacist - Clinical Programs Manager (Days)
Texas Children's Hospital · Bellaire, TX
- On site
- Full-time
- $120,000 / year
- Bellaire, TX
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Subject: Interested in the Pharmacist - Clinical Programs Manager (Days) role at Texas Children's Hospital
Hi Alex — I came across the Pharmacist - Clinical Programs Manager (Days) opening and wanted to reach out directly. I've spent the last few years doing exactly this kind of work, and Texas Children's Hospital stood out because…
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Job highlights
- Lead pharmacy clinical programs and initiatives.
- Conduct utilization reviews and manage appeals.
- Drive quality improvement and operational goals.
- Educate members, providers, and staff.
- Contribute to health plan policy development.
About the role
Clinical Programs Manager Pharmacist
We’re looking for a Clinical Programs Manager Pharmacist, someone who’s ready to grow with Texas Children's Hospital. In this position, you will be a key driver of pharmacy-based clinical programs, disease management initiatives, provider education, and utilization management review. This is an individual contributor role without direct reports but requires indirectly leading initiatives and other staff. This position works closely with leadership and other key personnel to execute operational goals, ensure quality control, and identify process improvement opportunities. The role serves as a resource and mentor to members, network providers, employees, and external collaborators.
Job Duties & Responsibilities
- Independent utilization review of clinician-administered drugs, and pharmacy appeals, and collaboration with the medical director team supporting benefit administration, policy development, and outcome tracking/reporting.
- Manage and enhance pharmacy-based clinical and quality improvement initiatives for the health plan impacting member benefits and health outcomes.
- Ensure clinical projects and tasks are completed in a timely manner, and operational goals are met. Uses data to measure quantifiable outcomes and interventions, presenting progress to the leadership team. Provides support staff with guidance to ensure achievement of goals.
- Manages and leads various clinical programs. Examples include but are not limited to: The Office of Inspector General (OIG) lock-in program, psychotropic medication utilization review (PMUR), retrospective drug utilization review (RDUR), prospective drug utilization review (PDUR), and others.
- Coordinates and participates in performance and/or quality improvement activities. Identify process improvement opportunities. With support from the leadership team, present and execute improvement plans.
- Participates in and leads multi-disciplinary workgroups involving clinical operations, NCQA accreditation compliance, and pharmacy benefit manager (PBM) oversight. This includes internal and external stakeholders.
- Creates pharmacy guides and training content for internal and external stakeholders.
- Completes clinical and compliance tasks.
- Participates in the education of parents/members, providers, employees, and pharmacy students.
- Performs other essential functions.
About Texas Children's Health Plan
Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.
Key Skills/Competency
- Clinical Pharmacy Programs
- Utilization Management
- Health Plan Operations
- Quality Improvement
- Provider Education
- Managed Care Pharmacy
- Data Analysis
- Policy Development
- NCQA Accreditation
- Pharmacy Benefit Management (PBM)
Skills & topics
- Clinical Programs Manager
- Pharmacist
- Managed Care Pharmacy
- Utilization Management
- Health Plan
- PBM
- Quality Improvement
- Provider Education
- Drug Utilization Review
- Healthcare Management
How to get hired
- Tailor your resume: Highlight your managed care experience, utilization management skills, and any PBM or health plan work.
- Showcase leadership potential: Emphasize your ability to indirectly lead initiatives and mentor others, even without direct reports.
- Prepare for behavioral questions: Be ready to discuss your experience with clinical programs, quality improvement, and stakeholder collaboration.
- Understand the company: Research Texas Children's Health Plan's mission and its role in serving children and families in Houston.
Technical preparation
Behavioral questions
Frequently asked questions
- What is the primary focus of the Clinical Programs Manager Pharmacist role at Texas Children's Hospital?
- The Clinical Programs Manager Pharmacist role at Texas Children's Hospital focuses on driving pharmacy-based clinical programs, disease management, provider education, and utilization management within the health plan. You'll be instrumental in enhancing member benefits and health outcomes.
- Is this a management position with direct reports at Texas Children's Hospital?
- No, this is an individual contributor role. While you won't have direct reports, you will be expected to indirectly lead initiatives and guide other staff members in achieving program goals.
- What specific clinical programs might I manage as a Clinical Programs Manager Pharmacist?
- You may manage various programs such as the Office of Inspector General (OIG) lock-in program, psychotropic medication utilization review (PMUR), retrospective drug utilization review (RDUR), and prospective drug utilization review (PDUR), among others.
- What qualifications are essential for the Clinical Programs Manager Pharmacist role?
- A Bachelor of Science in Pharmacy or Pharm.D., a Texas Pharmacist (RPH) license, and at least 3 years of managed care experience in utilization management, analytics, or formulary management are required. 1 year of Managed Care Pharmacy Residency experience is preferred.
- How does Texas Children's Health Plan contribute to the community?
- Texas Children's Health Plan was the nation's first health maintenance organization (HMO) created specifically for children. It provides essential health coverage (STAR/Medicaid and CHIP) to pregnant women, teens, children, and adults in the Houston area, serving over 375,000 members.
- What kind of collaboration is expected in this role?
- You will collaborate closely with leadership, network providers, employees, external collaborators, and participate in multi-disciplinary workgroups focused on clinical operations, NCQA accreditation, and PBM oversight.
- Does this role involve creating educational materials?
- Yes, a significant part of the role involves creating pharmacy guides and training content for both internal and external stakeholders, including parents, members, providers, employees, and pharmacy students.