Pharmacy Clinical Coordinator

Pharmacy Clinical Coordinator at CareOregon

This position is responsible for assisting with the management of the pharmacy benefit and developing and delivering clinical and educational interventions designed to improve pharmaceutical use. Responsibilities include formulary management; assisting with management of specific patients in the multidisciplinary case management/medication therapy management program, P&T, developing and conducting educational initiatives to improve prescribing patterns; develop and conduct quality improvement programs related to the pharmacy program; evaluating medication authorization requests and providing oversight to the medication PA process; and other pharmacy program activities as assigned.

NOTE: This is a temporary position expected to last 9 months.

Essential Responsibilities

• Prepare drug utilization reports and analyses for the Pharmacy & Therapeutics Committee.
• Use an evidence-based process to perform new drug reviews, and to develop formulary recommendations and drug use criteria for the Pharmacy & Therapeutics Committee.
• Critically evaluate drug therapy regimens for patients enrolled in the case management program and assist with developing treatment plans.
• Provide medication therapy management services.
• Develop and conduct retrospective drug use reviews.
• Review medication prior authorization requests and appeals.
• Develop and implement clinical educational programs to improve drug utilization and quality.
• Review and refine policies and procedures regarding Pharmacy Department functions including medication therapy management, DUR programs, medication prior authorization, and others.
• Develop and conduct quality improvement programs related to the pharmacy program.
• Monitor functions provided by the plans’ Pharmacy Benefit Manager including pharmacy benefit coding, customer service guidelines, prior authorization activities, and other delegated services.
• Develop and critically evaluate pharmacy claim data analysis/reports in support of specific projects or program objectives.
• Assess, review, and respond to federal and state regulatory requirements/audits of the pharmacy benefit.
• Consult with clinicians and pharmacists to resolve pharmacy benefit issues.
• Review and refine pharmaceutical reimbursement and purchasing procedures.
• Develop materials to communicate pharmacy benefit or other information to members, clinicians, and pharmacists.

Required Experience and Education

• Graduate of an accredited pharmacy program
• Current, unrestricted license as a pharmacist in Oregon
• Advanced pharmacy training (PharmD, residency, fellowship, or master’s degree in related discipline)
• Practical experience as a clinical pharmacist in formulary management or ambulatory care or other clinical setting

Preferred Experience

• Previous experience in managed care
• Experience with reviewing Prior Authorization requests against plan criteria and making approval or decline decisions

Knowledge, Skills And Abilities Required

Knowledge

• Must have comprehensive, clinical pharmaceutical knowledge base
• Knowledge of the principles of managed care, pharmacy benefit management, pharmaceutical reimbursement, and pharmaceutical utilization

Skills And Abilities

• Ability to critically evaluate clinical pharmaceutical and medical literature and apply principles of evidence-based medicine
• Ability to design and review pharmacy claims analysis/reports according to specific project requirements
• Must be highly motivated and have the ability to work independently
• Excellent organizational, project management, and time-management skills
• Excellent written and verbal communication skills
• Excellent customer service skills
• Ability to manage multiple tasks
• Ability to negotiate, problem-solve, and consensus-build
• Basic word processing, spreadsheet, and database skills
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to lift and carry for at least 1-3 hours/day

Working Conditions & Benefits

This is a remote, work-from-home position. CareOregon offers a strong Total Rewards Program, including competitive pay, bonus opportunity (SIP Target, 5% Annual), and a comprehensive benefits package for eligible employees. Benefits include medical, dental, vision, life, AD&D, disability, HSA, FSA, lifestyle spending account, EAP, wellness programs, and a strong retirement plan. Employees accrue PTO and Paid State Sick Time.

Key skills/competency

• Formulary Management
• Medication Therapy Management (MTM)
• Prior Authorization (PA)
• Drug Utilization Review (DUR)
• Pharmacy & Therapeutics (P&T) Committee
• Clinical Education
• Quality Improvement (QI)
• Pharmacy Benefit Management (PBM)
• Claims Data Analysis
• Regulatory Compliance