Clinical Intervention Pharmacist-Paramount Health Job Listing at Medical Mutual in OH (Job ID 2400534)

Description

Note, this is a fully remote opportunity in Ohio.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Responsibilities

Clinical Intervention Pharmacist I

As assigned, supports any of the following pharmacist specialty areas; formulary and policy development, intervention programs for commercial and Medicare programs, partnering with sales team, or health systems liaison. Develops and implements evidence based clinical programs to ensure that members receive the most clinically appropriate medication cost-effectively. Evaluates evidence and applies these principles to patient care. 

Based on assigned pharmacist specialty area, may include any of the following (% of time per function will vary):

·       Develops policies and strategies to engage members and/or providers and help drive improvements in pharmaceutical care and pharmacy quality measures to decrease drug spend.

·       Addresses Medicare STAR drugs (STATIN, RASA, and non-insulin diabetes) adherence gaps.

·       Reviews drug/medical literature, clinical practice guidelines, quality measures, and available national guidelines to support formulary, drug policy or drug therapy interventions and creation of new initiatives.

·       Contributes with PBM/vendor oversight activities including regular or ad-hoc audits of clinical programs.

·       Collaborates with pharmacy team members in the development and implementation of programs to communicate and educate internal staff, external brokers, strategic health systems, pharmacy chains and provider groups. 

·       Performs Consumer Assessment of Healthcare Providers and Systems (CAHPS)-focused interventions to improve drug plan perception.

·       Assists Sales in selling and renewing pharmacy services, or retaining business, by attending meetings, promoting pharmacy benefits and services, developing responses to Request for Proposal (RFP), recommending solutions to brokers and their clients, etc.

·       Collaborates with pharmacy departments within the Company's strategic health systems, pharmacy chains and provider groups to implement programs which better engage members to improve overall medication quality performance and cost of care for attributed populations by facilitating regular interactions to build and support the clinical relationship. 

·       Assists in closing Medicare STARS-related gaps by completing Comprehensive Medication Reviews (CMRs), Medication Reconciliation Post-Discharge (MRPs), and In-Home Assessments (IHAs).

·       Partners with internal departments including Medicare STARS, Clinical Quality Health Services, Provider Network Management, HEDIS, and Customer Care to develop and implement programs and clinical initiatives to support achievement of strategic goals. 

·       Builds and maintains and clinical knowledge and knowledge of prescription benefit trends.

·       Performs other duties as assigned.

Clinical Intervention Pharmacist II

As assigned, supports any of the following pharmacist specialty areas; formulary and policy development, intervention programs for commercial and Medicare programs, partnering with sales team, or health systems liaison. Develops and implements evidence based clinical programs to ensure that members receive the most clinically appropriate medication cost-effectively. Evaluates evidence and applies these principles to patient care. 

Based on assigned pharmacist specialty area, may include any of the following (% of time per function will vary):

·       Develops policies and strategies to engage members and/or providers and help drive improvements in pharmaceutical care and pharmacy quality measures to decrease drug spend.

·       Addresses Medicare STAR drugs (STATIN, RASA, and non-insulin diabetes) adherence gaps.

·       Reviews drug/medical literature, clinical practice guidelines, quality measures, and available national guidelines to support formulary, drug policy or drug therapy interventions and creation of new initiatives.

·       Interacts with PBM/vendor oversight activities including regular or ad-hoc audits of clinical programs.

·       Develops and implements programs to communicate and educate internal staff, external brokers, strategic health systems, pharmacy chains and provider groups. 

·       Performs Consumer Assessment of Healthcare Providers and Systems (CAHPS)-focused interventions to improve drug plan perception.

·       Promotes the value-add of the Company's pharmacy services with internal and external stakeholders. Develops relationships and partnerships to support health systems engagement or sales efforts.

·       Assists Sales in selling and renewing pharmacy services, or retaining business, by attending meetings, promoting pharmacy benefits and services, developing responses to Request for Proposal (RFP), recommending solutions to brokers and their clients, etc.

·       Collaborates with pharmacy departments within the Company's strategic health systems, pharmacy chains and provider groups to implement programs which better engage members to improve overall medication quality performance and cost of care for attributed populations by facilitating regular interactions to build and support the clinical relationship. 

·       Assists in closing Medicare STARS-related gaps by completing Comprehensive Medication Reviews (CMRs), Medication Reconciliation Post-Discharge (MRPs), and In-Home Assessments (IHAs).

·       Partners with internal departments including Medicare STARS, Clinical Quality Health Services, Provider Network Management, HEDIS, and Customer Care to develop and implement programs and clinical initiatives to support achievement of strategic goals. 

·       May orient, train, and assist new hires, residents, and junior level Pharmacists. Maintains and shares clinical knowledge and knowledge of prescription benefit trends.

·       Performs other duties as assigned.

Senior Clinical Intervention Pharmacist

Develops strategies and engages members and/or providers to conduct clinically and financially meaningful interventions that impact member drug therapy. These interventions are aimed at improving pharmaceutical care for our members, reducing total cost of drug therapy, and improving pharmacy related quality measures such as Medicare STARS and HEDIS. Leads team in different projects and goals. Acts as new employee trainer and support for training of new initiatives and projects and as a resource for colleagues with less experience.

·       Conducts targeted member and/or provider clinical interventions to ensure appropriate and cost-effective member drug therapy.

·       As assigned, addresses Medicare STAR drugs (STATIN, RASA, and non-insulin diabetes) adherence gaps.

·       Performs Consumer Assessment of Healthcare Providers and Systems (CAHPS)-focused interventions to improve drug plan perception.

·       May lead projects for existing staff and acts as a resource to newly hired staff, supporting management with training, assigned projects, and goals.

·       Develops strategies to engage members and/or providers and help drive improvements in pharmaceutical care and pharmacy quality measures to drive down drug spend.

·       Assists in closing Medicare STARS-related gaps by completing Comprehensive Medication Reviews (CMRs), Medication Reconciliation Post-Discharge (MRPs), and In-Home Assessments (IHAs).

·       Reviews drug/medical literature, clinical practice guidelines, quality measures, and available national guidelines to support drug therapy interventions and creation of new initiatives.

·       Develops written materials designed to enhance member adherence and other quality measures including appropriate use of medications and messaging campaigns. Provides internal professional staff and external provider education related to pharmacy drug therapy interventions.

·       Orients, trains, and assists new hires, residents, and junior level Pharmacists. Develops and maintains policies and procedures to support team as needed. Maintains and shares knowledge of prescription benefit trends.

·       Represents the department or division in activities or projects as assigned by management.

·       Performs other duties as assigned.

Qualifications

Clinical Intervention Pharmacist I

·       Doctor of Pharmacy (Pharm.D.) preferred. Bachelor of Pharmacy with relevant experience may be considered.

·       Successful completion of internal Clinical Pharmacy Resident program, or 0 to 3 years of experience as a Clinical Pharmacist, or equivalent experience in a managed care pharmacy setting.

·       Medicare/Medicaid experience preferred.

·       Registered Pharmacist with current unrestricted license from the appropriate State Board of Pharmacy.

·       May be required to obtain Ohio State Board of Pharmacy license within 6 months of hire.

·       Understanding of managed care pharmacy, including formulary design/management, drug utilization management, and/or quality assurance programs.

·       Knowledge of medical/pharmacy terminology/coding and specialty drug management.

·       Good clinical acumen.

·       Microsoft Office skills specifically Excel and Pharmacy Benefit Management (PBM) systems; basic proficiency with Visio and/or Access.

·       Ability to present clinical information to various internal and external audiences.

Clinical Intervention Pharmacist II

·       Doctor of Pharmacy (Pharm.D.) preferred. Bachelor of Pharmacy with relevant experience may be considered.

·       3 years of experience as a Clinical Pharmacist or equivalent experience in a managed care pharmacy setting.

·       Medicare/Medicaid experience preferred.

·       Registered Pharmacist with current unrestricted license from the appropriate State Board of Pharmacy.

·       May be required to obtain Ohio State Board of Pharmacy license within 6 months of hire.

·       Understanding of managed care pharmacy, including formulary design/management, drug utilization management, and/or quality assurance programs.

·       Knowledge of medical/pharmacy terminology/coding and specialty drug management.

·       Good clinical acumen and strategic analysis skills.

·       Microsoft Office skills specifically Excel and Pharmacy Benefit Management (PBM) systems; basic proficiency with Visio and/or Access.

·       Ability to present clinical information to various internal and external audiences.

Senior Clinical Intervention Pharmacist

·       Doctor of Pharmacy (Pharm.D.). In lieu of Pharm. D., may consider Bachelor of Pharmacy with relevant experience.

·       5 years of experience as a Clinical Pharmacist in a managed care pharmacy setting.

·       Medicare/Medicaid experience preferred.

·       Registered Pharmacist with current unrestricted license from the appropriate State Board of Pharmacy.

·       May be required to obtain Ohio State Board of Pharmacy license within 6 months of hire.

·       Comprehensive understanding of managed care pharmacy, drug utilization management, population health, and quality programs.

·       Knowledge of medical/pharmacy terminology/coding and specialty drug management.

·       Strong clinical acumen and strategic analysis skills.

·       Advanced Microsoft Office skills; basic proficiency with Visio and/or Access.

·       Ability to work independently.

·       Strong project management skills.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.