Managed Care Clinical Pharmacist - Community Health Choice
Harris Health System
Location: Houston, Texas
Type: Full Time
Internal Number: 158029
JOB SUMMARY:The Clinical Pharmacist provides highly specialized integrated clinical pharmacy services to the health plan. The Pharmacist will provide drug utilization reviews based on establish protocols for prior authorization and appeal requests, and to provide educational outreach to prescribers as appropriate.
The Managed Care Clinical Pharmacist will assist with:
Developing prior authorization review criteria for medications covered on pharmacy and medical benefits
Conduct oversight over prior authorization criteria and delegated utilization management functions performed by PBM
Reviewing PBM's formularies to identify improvement opportunities
Create and refine policies and standard operating procedures for pharmacy operation processes
The Pharmacist may be responsible for other functions as assigned to ensure quality care for members while meeting expectations for prescription drug cost containment; and assisting with the development of clinical initiatives that support the processes of prior authorization, plan designs, formulary management, provider/member communication, retrospective drug utilization review and clinical consultation with members and providers.
1. Education/Specialized Training/Licensure:
Bachelor's Degree in Pharmacy required;
Must be a Texas registered pharmacist
2. Work Experience (Years and Area):
2 year of applicable experience as a registered pharmacist with managed care experience.
Experience with prior authorization management.
Medicare, Medicaid, and Marketplace experience with a Health Plan or PBM preferred.
3. Management Experience (Years and Area): N/A 4. Software Operated: Microsoft Office (Word, Excel, Outlook)
SPECIAL REQUIREMENTS: (Check Applicable Areas)
1. Communication Skills: Above Average Verbal (Heavy Public Contact) Exceptional Verbal (e.g., Public Speaking) Writing /Composing: Correspondence / Reports
2. Other Skills:
3. Advanced Education: Advanced Training Specialty: Completion of a pharmacy residency is strongly preferred. Bachelor or Doctor of Pharmacy degree from an accredited school of pharmacy required 4. Work Schedule: Flexible
The Harris Health System is a fully integrated healthcare system that cares for all residents of Harris County, Texas. We are the first accredited healthcare institution in Harris County to be designated by the National Committee for Quality Assurance as a Patient-Centered Medical Home, and are one of the largest systems in the country to achieve the quality standard. Our system includes 23 community health centers, five school-based clinics, a dental center and dialysis center, mobile health units, a rehabilitation and specialty hospital and two full-service hospitals.Ben Taub Hospital is a world renowned Level I Trauma Center with 586 licensed acute-care beds and provides a wide range of specialty care outpatient services. Lyndon B. Johnson Hospital is a 328 licensed bed acute-care hospital with a newly expanded Level III trauma center and a distinguished regional center for neonatal intensive care for high-risk deliveries.Harris Health is a teaching system for Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth). We train the next generation of healthcare providers on the latest medical procedures and technological breakthroughs.With... our fully integrated electronic medical records system, we offer patients the convenience and assurance that their medical history is accurate, safe and available when and where it is needed. Our Medical Home designation ensures that we offer a full range of preventive, specialty and acute care services for the entire family.