Pharmacist

Work at Home
Immediate

Job Description

Innovative, Dynamic, Fast Pace and Collaborative, these are just some of the words that our employees use to describe us but hey - don’t just take it from us - become a part of BroadPath today and experience our Culture of Constant Connection! At BroadPath we strive to transform the modern workplace by embracing the spirit of revolution coupled with advanced technology to create an experience out of every day. BroadPath is excited to be hiring a Pharmacist. This position supports all aspects of pharmacy services within the Insurance Division, including utilization management, care management, and pharmacy quality responsibilities. This position drives optimal member experience, provider experience, and financial performance through assigned areas of work. Incumbents maintain a high degree of clinical acumen, and leverages strong organizational, communication, and execution skills to ensure the successful deployment of pharmacy benefits across all populations. This role is highly independent, and incumbents work across departments, and with internal and external stakeholders.

Responsibilities

  • Provides management of pharmacy services to Insurance Division members, including commercial, Medicare, Medicaid populations within owned/operated health plans as well as value-based agreements. Identifies and stratifies members based on complex pharmaceutical care needs to optimize pharmacotherapy regimens at the patient/member level, and population level to improve overall healthcare quality and reduce costs that is consistent with acceptable standards of pharmacy practice and CMS Medicare Part D regulations and guidance. Analyzes and interprets pharmacy and medical claims reporting and other sources of clinical and economic data to generate insights and clinical service opportunities.  

  • Active participant and/or leader in defining, implementing, and managing clinical programs and services that improve pharmaceutical care quality and lowers costs in all Insurance Division lines of business. Programs include but are not limited to, medication therapy management, pharmacy quality measure performance, utilization management, member outreach and engagement, provider education and detailing, drug utilization reviews, or formulary monograph development. 

  • Maintains proficiency in all legal, regulatory, and practice standards related to CMS, AHCCCS, or out-of-state Medicaid programs. Maintains proficiency in all pharmacy related URAC, NCQA, or other applicable accreditation standards. Maintains clinical proficiency in assigned clinical area(s) through continuing education. 

  • Conducts utilization management reviews and adjudicates prior authorization requests and appeals. Participates in multidisciplinary appeals and grievances reviews as assigned. Takes ownership to identify and resolve utilization management issues and promotes a best-in-class member and provider experience and optimal clinical outcomes for the member.  

  • Communicates with and supports Insurance Division members and network providers and support staff, Health Plan leaders, and Insurance Division executives concerning pharmacy issues and programs and services. Works closely with pharmacist and pharmacy technician team members to contribute to a high-performing team. 

  • Applies the principles of continuous quality improvement consistent with job expectations. Incorporates quality improvement principles into other activities and projects (i.e. data collection, documentation). 

  • May be assigned to collaborate with technical experts to create data extracts of pharmacy, eligibility, provider, or medical claims data for health plan pharmacy utilization management and audit functions. 

  • Participates in student and resident learning experiences, including as primary and supportive preceptor as assigned. 

  • Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day. 

 


 

Basic Qualifications

  • Must possess a degree in Pharmacy (advanced degree preferred) from an accredited College of Pharmacy. 

  • Completion of an accredited PGY1 pharmacy residency program or three years of previous clinical pharmacy experience in the managed care, community pharmacy, or ambulatory care setting. 

  • Requires current and unrestricted pharmacy licensure in the applicable state of practice within 90 days of hire date. 

  • Requires a proficiency level in managed care/health plan or pharmacy benefits experience typically obtained in 2 years. Requires effective human relations and verbal/written communication skills and the ability to work collaboratively with community-based practitioners and the senior population is essential.  

  • An understanding of the interrelationships of health plan pharmacy components, members, and providers is required. 

  • Proficiency with PC based productivity tools (e.g. spreadsheets, word processing, e-mail) required. Needs analytical ability to support decision making; organizational ability to manage multiple tasks and projects by established deadlines. 

 


Preferred Qualifications

  • Geriatric certification is a plus; experience with Medicare Part D is a plus.
  • Additional related education and/or experience preferred.