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Join a dynamic team of Population Health Clinical Pharmacists, Population Health Specialists, Care Management Team Members, and other members of our population health team to improve pharmacotherapy for Banner's members!Our Population Health Clinical Pharmacist will participate in the design and delivery of designated population health initiatives that aim to optimize medication therapy for members of Banner Health's Insurance Division. These data-driven initiatives will focus on quality, cost, and care coordination. The pharmacist will also work with a team of certified pharmacy patient advocates by providing clinical support where needed and actively participate in residency and student programs related to population health pharmacy. Previous PBM knowledge, prior authorization, and/or Medicare Part D experience is preferred.
We are hiring a full-time Population Health Clinical Pharmacist to join our team in Phoenix, AZ! This full-time pharmacist will work 40 hours per week, Monday-Friday, between 8am to 6pm. Our Population Health Clinical Pharmacist team currently consists of 5 pharmacists who rotate taking on call one week at a time; this pharmacist will join our call/weekend/holiday rotation. Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits.??
Banner Pharmacy Services division provides excellent patient care across our entire continuum through convenient access, improved medication outcomes and innovative pharmacy practices. Banner Pharmacy Services will be recognized nationally as a clinical leader and trusted partner in proactively providing innovative pharmacy services through excellence in integration, care coordination, medication management and service to make a difference in people's lives. Banner is expanding its focus from being a hospital company to a clinical quality company focused on population health management. Clinical Pharmacy Services are also included in this robust new service line and are responsible for the management of the Banner formulary, development of standardized system wide clinical pharmacy services, and management of adverse drug event preventions. Clinical Pharmacy Services provides collaborative drug therapy management and educational interventions in patient care to optimize medication therapy, improve outcomes, promote wellness, and disease prevention.
POSITION SUMMARY This position supports all aspects of pharmacy services within the Banner Health 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.
CORE FUNCTIONS 1. 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.
2. 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.
3. 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.
4. 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.??
5. 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.
6. 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).
7. 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.
8. Participates in student and resident learning experiences, including as primary and supportive preceptor as assigned.
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.
What might draw you to Banner Health? A great health care career, of course—and a great place to live, no matter what stage of life you’re in. With facilities across the West, there is a health care career for everyone, from big city living in the Phoenix area to friendly small towns in the mountains and plains. As one of the largest nonprofit health systems in the country, Banner Health offers both the stability that comes with success and the possibility of exploring new areas of the country. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages:
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 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.
Competitive compensation and comprehensive benefits offer you options to complement your unique needs.