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Ld Phar Spec - Pharmacoeconomics/ SRS/ Full-Time/ Variable

Job ID JR116329 Date Posted 01/12/2022
San Diego, California
  • Copley Drive
  • Variable
  • Regular
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What You Will Do
Oversee managed care operations of pharmacy services at Sharp Rees Stealy Medical Group, and be a liaison for pharmaceutical utilization and related issues within the managed care population.

Required Qualifications

  • Doctor of Pharmacy (PharmD)

  • 5 Years clinical experience in a managed care environment, combining use of analytical methods to monitor and measure cost and quality aspects of pharmacy benefit programs; or equivalent combination of education and experience.

  • Current unencumbered CA Pharmacist License

Preferred Qualifications

  • Completion of a Pharmacy Residency related to acute/ambulatory care services.

  • BPS Board Certified Ambulatory Care Pharmacist (BCACP) - Board of Pharmacy Specialties

Essential Functions

  • Community
    DMHC performance improvement initiatives.
    AMCP membership - Managed Care Pharmacy Society.

  • Finance
    Individualized financial goals for department meets or exceeds currents year's budget.
    Health Plan pharmaceutical care incentives to be captured and dollars allocated for pharmacy services to be maximized. Pharmacoeconomic outcomes of department projects are measured and reported through financial or related outcomes research.

  • Leadership and Operations
    Develop and promote the business unit’s vision, goals, and objectives in support of the overall objectives in conjunction with the Clinical Supervisor, Pharmacy Benefits Administration, and the Director of Pharmacy Services, Sharp Rees-Stealy.
    Provide analysis and recommendations to relevant specialties (e.g. physicians, interdisciplinary departments within SHC) to support most efficient utilization of pharmacy products.
    Educate managed care team on the clinical aspects of medication Prior Authorization Request (PAR) criteria.
    Support managed care team to develop and implement appropriate training programs and operational procedures related to medications, per business needs.
    Participation in Sharp Rees-Stealy Medical Group's Pharmacy, Diagnostics, & Therapeutics (SRS PD&T) Committee meeting and preparation and presentation of drug information on all agents considered for drug formulary review and inclusion, relative to safety, efficacy and cost and health plan coverage.
    Coordinate with SRS Specialty Physician groups to regulate appropriate prescribing and utilization of high-cost drugs in conjunction with SRS PD&T Chairman.
    Collaborate with Utilization Management (UM) department to be a lead consultant on appropriate or alternative methods of pharmaceutical care and drug utilization wherever appropriate.
    Provides the professional, clinical and technical knowledge (pharmacy and information systems) to ensure all state and federal regulations are satisfied, and the integrity and analysis of pharmacy data is sound.
    Analyzes and interprets reports data pertinent to managed care workflow, as required.
    Participates in the coordination and expansion of the Sharp pharmacy resident and/or student clinical teaching program.
    Serve as a liaison, advisor and educator to effected population: physicians, office staff or other SHC departments (to include System Pharmacy).
    Interfaces with others (SRS wholesale, Medical Groups, Health Plans, Vendors, SHC leadership) to achieve managed care goals and objectives of SRSMG. Assures that all tasks are accomplished during allotted timeframe.

  • Quality assurance
    Participation in pharmaceutical utilization management collaboration within medical staff, including pharmacy clinics.
    Maintain turnaround time for prior authorization determination to meet or exceed all compliance standards. Clinical evidence to support decisions is current, properly annotated and readily retrievable.
    Support managed care team to develop and implement appropriate medication audit process per regulatory requirements.
    Ensures accurate processing of all Durable Medical Equipment (DME) and injectables including but not limited to diagnosis code, modifiers, and referral numbers.
    Recommendations regarding pharmaceutical usage that benefits entire SHC system. Dialogue with all parties will maintain focus on safety, efficacy, and cost.
    Advises and educates internal and external populations relative to pharmaceutical care. Advises and educates on pharmacy components of managed care in the context of existing teaching program.
    Develop potential for expanded research opportunities in collaboration with Sharp Outcomes Research Institute.

Knowledge, Skills, and Abilities

  • Expert in clinical application of pharmacy practice and a good working knowledge of all types of pharmacy services, with an emphasis on the managed health care environment.

  • Knowledge and understanding of SHC policies and procedures.

  • Knowledge of medical groups and contracts.

  • Able to communicate effectively and direct personnel.

  • Works effectively and constructively with all members of the health care team.

  • Knowledge of fiscal and budgetary issues concerning pharmacy services.

  • Possesses the legal and technical knowledge to effectively perform duties of position.

  • Must have in-depth knowledge of state and federal regulations regarding pharmacies, medical practices, and managed care.

  • Demonstrates expertise in all aspects of clinical pharmacy services.

  • Ability to utilize resources in an organized manner.

  • Strong professional level of written and oral communication skills.

  • High level of computer and analytical skills required.

  • Ability to diffuse volatile situations, and use good judgment and tact.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class

BPS Board Certified Ambulatory Care Pharmacist (BCACP) - Board of Pharmacy Specialties; California Pharmacist License - CA State Board of Pharmacy; Doctor of Pharmacy (PharmD)
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