Population Health Clinical Pharmacist

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As a Population Health Clinical Pharmacist, you will use clinical knowledge to review medication prior authorization requests against set clinical criteria. You will also review chart notes and labs from providers to ensure criteria have been met or should be denied. You'll be expected to select appropriate letter and/or fax template to notify providers/members of decision and/or request additional information and you must document all decisions following standard template. You may interact with providers (and rarely members) for additional information and/or to provide education about criteria

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.

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