PharmD or BA/BS in Pharmacy with an active New Jersey Pharmacist license
2-5 years of experience in health plans/Medicare clinical customer service or retail management
Project management experience and knowledge of health plans or the Medicare industry, including CMS Star/HEDIS metrics
Strong communication and interpersonal skills, ability to work independently and as part of a team, proficiency with Microsoft Office Suite (Excel, PowerPoint, Access) and basic financial analysis
Requirements:
Lead outreach and pull-through for Star/HEDIS clinical programs; coordinate between the pharmacy department, health systems, and Magellan to drive 5-Star Medicare Part D outcomes (Adherence: DM/RAS/Statins; SUPD; CMRs for MTM)
Oversee daily clinical activities related to Star/HEDIS measure goals across health systems and ensure clinical goals and objectives are met
Identify Star/HEDIS-related issues and implement and monitor clinical pharmacy solutions, serving as a liaison to drive adoption of recommendations
Develop, review and monitor clinical programs, therapeutic initiatives, care pathways, and drug-use policies for Star/HEDIS; track patient interventions and report on quality, care and cost impact with the data team
Job description
Our Client, a Health Insurance company, is looking for a Clinical Pharmacist for their Newark, NJ location.
Responsibilities:
The information above is intended to describe the general nature of the work being performed by each incumbent assigned to this position.
This job description is not designed to be an exhaustive list of all responsibilities, duties, and skills required of each incumbent.
Clinical pharmacist will be responsible for managing outreach efforts and pull-through for Star/HEDIS clinical programs.
Coordinate between the pharmacy department, health systems, and Magellan.
Clinical pharmacist will be responsible for driving results to obtain 5-Stars for Medicare Part D Star clinical programs including Adherence (DM, RAS, Statins), SUPD, and CMRs for MTM.
Oversee the daily clinical activities related to Star/HEDIS measure goals for various health systems.
Ensure clinical goals and objectives are met.
Identify problems related to Star/HEDIS measures that require a clinical solution, implement and monitor clinical pharmacy solutions in support of Horizon’s Star/HEDIS goals to save money and improve care.
Major responsibility is to serve as clinical liaison between Horizon pharmacy department and health systems, assisting with managing overall relationship and driving adoption of recommended clinical solutions.
Develop, review and monitor clinical programs, therapeutic initiatives, pathways of care and other drug use policies and practices in support of Star/HEDIS initiatives. Works closely with the pharmacy department managers, vendors, and health systems to ensure execution of programs.
Maintain continuity among health systems by communicating and documenting program design and execution in accordance with pharmacy department expectations. Track, analyze and report on patient interventions, interactions and findings of disease management activities..
With support of the Horizon data team, develop and track the appropriate metrics to monitor the quality, care, and cost impact of the Star/HEDIS program and monitor overall healthcare trends within the Medicare populations.
Conduct member, provider, and pharmacy outreach/interventions and Comprehensive Medication Reviews as needed to achieve Stars goals.
The position requires communication across all departments; an understanding of the strategic impact of the programs; and extensive knowledge of how the Star/HEDIS programs integrate with other clinical initiatives.
Understand the financial impact of all clinical recommendations: Programs must address the impact on customers, operations, program integrity, pricing, quality and satisfaction.
Requirements:
BA/BS in Pharmacy or PharmD
Experience: 2-5years
Experience: Health plan or Medicare clinical customer service or Retail management position .
Project management experience and knowledge of health plans or Medicare industry.
ICONMA is an Equal Opportunity Employer. All qualified applicants will receive considerationfor employment without regard to any status protected by applicable law.
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