This position is responsible for maintaining and supporting the Medicare formulary and providing clinical and economic data necessary to make formulary decisions. This position acts as a pharmacy resource for network physicians, health plan members, medical services, care management, and member service staffs as well as other internal partners. Assists in performing all CMS mandated quality and compliance activities. Serves as a pharmacy topic educator and training resource to Medicare health plan departments and personnel.
Provides and assists with the management of pharmacy services to Medicare heath plan members that is consistent with acceptable standards of pharmacy practice and CMS Medicare Part D regulations and guidance.
Assists in defining, implementing and managing Medicare health plan pharmacy programs including the medication therapy and drug utilization management.
Directly interfaces with Medicare members, and network providers concerning pharmacy issues and programs. Designs and delivers staff/community educational programs and provides individual medication counseling, if appropriate.
Produces pharmacy utilization reports as well as clinical and economic data to the health plan and its Pharmacy & Therapeutics committee to assist in pharmacy benefit and formulary decisions.
Conducts audits and produces reports that can be utilized by the care management, quality and compliance departments to evidence quality pharmacy services and meets Medicare requirements.
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). Develops criteria for drug use evaluations, medication use indicators and disease-based evaluations.
May be assigned to create data extracts of the pharmacy claims system and support ad hoc report requirements for health plan pharmacy utilization management and audit functions.
Must possess a degree in Pharmacy (advanced degree preferred) from an accredited College of Pharmacy.
Requires pharmacy licensure in state worked.
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.
Geriatric certification is a plus; experience with Medicare Part D is a plus.
Additional related education and/or experience preferred.
Internal Number: 265747
About Banner Health
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.