Lead Clinical Pharmacy Specialist

Summary of Position

As a Lead Clinical Pharmacy Specialist at EmblemHealth, you will be instrumental in supporting the Pharmacy Quality program, with a dedicated focus on achieving corporate STAR goals. This role involves comprehensive engagement in the Comprehensive Medication Management (CMM) Program, where you will conduct patient interviews, develop, facilitate, and communicate tailored plans of care to overcome medication adherence barriers. You will continuously evaluate and refine these plans. Additionally, as part of the Medication Therapy Management (MTM) Program, you will perform and meticulously document annual comprehensive medication reviews in accordance with CMS standards.

Principal Accountabilities

Comprehensive Medication Management Program:

• Conduct in-depth patient medication history reviews both face-to-face and telephonically.
• Identify and collaboratively resolve patient-specific barriers to care.
• Recommend evidence-based changes in drug therapy and lifestyle, leveraging patient interviews, objective monitoring, drug profiles, and medical records.
• Proactively identify, resolve, and prevent medication-related problems such as untreated indications, improper drug selection, subtherapeutic dosage, overdose, non-adherence, adverse drug reactions, drug interactions, and unnecessary medication use.
• Provide continuous patient monitoring to optimize outcomes, drug utilization, and compliance, while minimizing adverse drug reactions and eliminating unnecessary duplication.
• Deliver comprehensive patient education on disease states, including predictable actions, potential side effects, the importance of compliance, and specific instructions.
• Accurately document all interactions and care plans within the designated software systems.

Medication Therapy Management Program:

• Deliver and timely document MTM services, assessing medication appropriateness, optimizing therapy, and improving clinical outcomes.
• Serve as a crucial drug information resource for patients and interdisciplinary teams.
• Coordinate medication reconciliation across the continuum of care by providing thorough reviews, addressing adherence concerns, assisting with patient education, and monitoring clinical outcomes to prevent readmissions, care lapses, and adverse drug reactions.
• Contribute to managing medication costs through cost-effective interventions, including formulary and therapeutic interchanges, and identifying unnecessary or duplicate therapies.
• Efficiently assess prescribed medication therapy for any unnecessary medications, need for additional medications, ineffective medications, inappropriate doses, adverse drug reactions, and adherence concerns.
• Determine and implement appropriate interventions to resolve medication therapy problems, achieve therapeutic goals, and prevent new issues.
• Collaborate effectively with prescribers, interdisciplinary care teams, patients, and caregivers to establish patient-specific disease state therapy goals.
• Professionally communicate and document clinical recommendations and interventions to all relevant parties.
• Ensure ongoing maintenance and compliance with clinical standards for CMMP and MTM services, staying current with clinical knowledge.
• Maintain comprehensive knowledge of policies and procedures, ensuring performance aligns with applicable regulatory and accreditation requirements.
• Assist in evaluating and maintaining formulary setup based on clinical requirements, regulatory compliance, and Pharmacy & Therapeutics (P&T) rules.
• Undertake other projects and duties as assigned.

Qualifications

• Bachelor’s Degree or PharmD from an accredited college of pharmacy.
• Current, unrestricted Pharmacist License in your respective state of residency.
• MTM training program completion (APhA or PowerPak C.E.) preferred.
• PGY-1 residency program (community pharmacy/ambulatory care/geriatric pharmacy/managed care pharmacy) preferred.
• Clinical Pharmacy Board Certified (via BPS or NBMTM) preferred.
• Fluent in an additional one or more languages preferred.
• 10+ years of relevant, professional work experience.
• 3 – 5 years of specific, position-related experience.
• Experience with administering CMS Comprehensive Medication Reviews.
• Managed care experience.
• Strong communication skills, including motivational interviewing.
• Strong clinical therapeutic skills; profound knowledge of appropriate medication dosing in geriatric and adult populations.
• Excellent critical thinking and problem-solving skills.
• Computer/technology competent.
• Industry-level understanding of STAR measures and strategies for improving service delivery to maximize ratings.
• Ability to work independently within a collaborative environment, be self-directed, and possess excellent organizational skills.
• Ability to work effectively with patients, their families, professionals, and personnel from diverse cultural, social, and economic backgrounds.
• Ability to communicate professionally with all parties involved in a patient’s care plan.

Key skills/competency

• Clinical Pharmacy
• Medication Therapy Management (MTM)
• Comprehensive Medication Management (CMM)
• Medication Adherence
• STAR Measures
• Patient Education
• Drug Information
• Regulatory Compliance
• Critical Thinking
• Communication Skills