As one of the nation’s largest not-for-profit Medicare Advantage plans, serving more than 200,000 members in California, SCAN Health Plan has been a mission-driven organization dedicated to keeping seniors healthy and independent for over 40 years. SCAN employees are passionate about what they do, and understand that success is based on achieving the mission. Employees are afforded with the training and tools necessary to do their jobs and are rewarded for their efforts and recognized as experts in their fields. To learn more, visit scanhealthplan.comor follow us on social media:LinkedIn; Facebook; andTwitter.
Develop and execute innovative pharmacy clinical programs to improve health outcomes, enhance quality, and manage costs. Influence change by working with providers, members and cross-functionally within the organization to develop effective end-to-end clinical programs. Evaluate and analyze data and outcomes to evolve and enhance initiatives and improve results.
Create, develop, implement, and monitor clinical programs to improve Medicare 5 Star Ratings quality metrics, medication or medical issues, and cost containment. This includes, but is not limited to, creating educational materials for members and providers, managing call campaigns, and partnering with vendors.
Serve as subject matter expert for specified pharmacy quality measures. This can include, but is not limited to, staying abreast of industry trends, performing deep dive root cause analyses, strategizing, identifying opportunities, and implementing initiatives to achieve results.
Own quality measure(s) to achieve high performance. This includes, but is not limited to, developing strategy, processes, and program implementation needed to achieve desired results.
Stay abreast of CMS rules, regulations, and quality metrics to ensure requirements are met with applicable programs.
Ensure smooth and timely execution of clinical programs by facilitating meetings and follow-up on key action items.
Effectively lead the collaboration with providers (e.g., medical groups, pharmacy networks) by supporting and guiding external initiatives, and identifying and acting on new opportunities.
Effectively communicate with various healthcare professionals internally and externally for successful collaboration and implementation of initiatives.
Design studies and analyze data to measure clinical program outcomes.
Develop performance metrics to monitor and drive improvements in quality. Analyze data and identify trends to enhance initiatives and develop innovative strategies.
Develop, coordinate, and implement an effective on-going strategy to achieve appropriate drug use goals and improvement in the quality of health outcomes.
Understand utilization and quality management techniques, drug trends, and issues in Medicare to effectively develop and implement strategies to improve health outcomes while reducing cost.
Participate in interdisciplinary team meetings to discuss patient cases and perform medication reviews to improve patient health outcomes.
Serve as a pharmacy liaison that provides training, analytical and educational support and on-going performance feedback to providers and staff regarding pharmacy initiatives.
Support other clinical programs cross-functionally aimed at improving quality measures and/or compliance requirements.
Maintain professional and technical knowledge by conducting research and by attending educational and technological workshops. This position requires contributions to team effort by accomplishing and sharing related results with other staff.
Coordinate and precept pharmacy clerkship students.
Other duties as assigned.
Pharm D. Degree required
Completion of residency/fellowship in Managed Care, Health Outcomes, Clinical, or Geriatric Pharmacy preferred.
Managed care experience in health plan, PBM, or medical group preferred.
Pharmaceutical and medical knowledge necessary to effectively discuss drug therapy issues with healthcare providers and members
Strong analytical, organizational, and communication skills
Strong leadership, including excellent interpersonal, problem-solving, negotiating skills, and accountability
Ability to work cross-functionally and collaboratively across the organization
Ability to think strategically and act tactically
Self-starter, innovative, and resourceful
Demonstrated ability to effectively multi-task to manage multiple priorities at once
Ability to work in a fast-paced, ever changing work environment
Working knowledge of applicable state and federal pharmacy regulations preferred.
What's in it for you?
A competitive compensation and benefits program
An annual employee bonus program
Generous paid-time-off (PTO)
Ten paid holidays per year
Excellent 403(b) Saving Plan, providing up to 4% match and vesting after three years
A work-life balance and much more!
We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!
At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.
SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employee will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
Internal Number: CLINI03639
About SCAN Health Plan
As one of the nation’s largest not-for-profit Medicare Advantage plans, serving more than 200,000 members in California, SCAN Health Plan has been a mission-driven organization dedicated to keeping seniors healthy and independent for over 40 years. SCAN employees are passionate about what they do, and understand that success is based on achieving the mission. Employees are afforded with the training and tools necessary to do their jobs and are rewarded for their efforts and recognized as experts in their fields. To learn more, visit scanhealthplan.com or follow us on social media: LinkedIn; Facebook; and Twitter.