In a few words…
The Clinical Services Pharmacist, also known as, possibly, “you”, has a dynamic role that requires comprehensive understanding and knowledge of pharmaceutical, biomedical, socio-behavioral and clinical sciences. You, as our Clinical Services Pharmacist, will have an important role in the development and execution of clinical programs designed with the major goal of improving health-related outcomes for our client’s beneficiaries. You will also partake in the daily execution of clinical programs. You’ll work in a few areas across the Clinical group with the goal of optimizing the use of medication, promoting health, wellness, and disease prevention among our clients’ beneficiaries through comprehensive and targeted medication reviews to identify, resolve, and prevent medication-related problems.
The fundamentals for the job…
- You’ll be performing comprehensive and targeted medication reviews to identify, resolve, and prevent medication-related problems and documenting the care delivered.
- By using prescription and medical claims data and client formulary information, you’ll be able to provide clinical recommendations.
- Make recommendations regarding gaps in care, high risk medications, drug interactions, therapeutic and generic substitution, compliance and adherence, among others Communicate essential information to beneficiaries’ primary care providers.
- Work with the Health Educator and Case Managers to ensure MTM and other clinical programs participants are receiving all the necessary and relevant information.
- Be a great source of support and keep abreast of advances in drug therapies and management of chronic conditions.
- Constantly evaluate, analyze, and look for methods to streamline processes to ensure improved patient care, outcomes, and program quality.
- Work with cross functional teams to plan and execute clinical projects, operationalize formularies and medication lists, and deliver the highest quality of service to clients and partners.
- Support CMS Medicare STAR initiatives, Medicaid’s Health Care Improvement Program and other clinical programs.
- Participate in government and internal audits, and in the Pharmacy & Therapeutics Committee, preparing presentations and clinical recommendations.
- Develop and document Clinical Policies and Procedures.
- Evaluate coverage determination request, ensuring that all coverage determinations and appeal responses are clinically appropriate and compliant.
- You’ll also assist in providing clinical support, including drug information to the PA Customer Service Teams, to ensure appropriate clinical decisions are made for beneficiaries, before, during, and after point of sale.
- Ensure CMS Compliance (Clinical).
- Other projects or duties as needed.
The bold requirements…
- Bachelor or Doctoral Degree in Pharmacy; (In lieu of a degree, equivalent relevant work experience may be considered.)
- Current/Active Pharmacy License for Puerto Rico.
- Knowledge of and/or experience with PBM clinical operations and Medicare Part D, that’s a healthy plus, as is experience with MTM or other clinical programs.
- Computer proficiency, knowledge of Microsoft Office products, and Internet experience (you know; the basic stuff).
- Clinical knowledge (a given), customer-service focused (you couldn’t fathom any other focus), excellent when providing context, scenarios or explaining situations (presentation skills), you ride changes with grace and help others weather adjustments, and you are one of the most detail-oriented people this side of the world.
- Must be able to communicate effectively (read, write, speak, daydream, argue, flatter, retort, joke, etc.) in English and Spanish.
That something extra we´d love to see…
- Empathetic: You are bound to inclusiveness and acceptance of others. You know how to connect and communicate with very different audiences, and are aware of those who feel left out, trying your best to include them. You should know how much this is appreciated and valued.
- Responsible: You own what you say and you are what you do. Your word is your bond; when you commit to something, you show up. You live by established values like honesty and loyalty (although sometimes you can be a bit sanctimonious and righteous).
- Strategic: You set a vision and devise ways to proceed. In any given scenario, you quickly spot the relevant patterns. There’s no point in playing games like “Memory” or “Pairs” because you always win. This is no fun for others (and bores you too).
- Driven: You are secretly very competitive (and everyone already knows). You measure yourself against everything and everyone, and strive to win at all costs. You beautifully manage multiple priorities without missing deadlines. Your type of obsessive mindset, properly harnessed, can be weaponized for the greater good.
5. Fixer / Solution seeker: You are like an action figure brought to life: you never give up, even when it’s obvious you are barking up the wrong tree. You like to provide comprehensive solutions, considering both, internal and external needs; your mantra is to always be part of the solution (not the precipitate). Those who precipitate, you’ve learned, repent at leisure.