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Anthem, Inc Pharmacist Clinical - Managed Care: (South Bay-CA, Long Beach-CA, Cerritos-CA) - PS27742 in Long Beach, California

Pharmacist Clinical - Managed Care: (South Bay-CA, Long Beach-CA, Cerritos-CA) - PS27742

Location: Cerritos, California, United States

Requisition #: PS27742

Post Date: Oct 11, 2019

Your Talent. Our Vision. At Anthem, Inc. , it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

Pharmacist Clinical - Managed Care: PS27742

Location(s): South Bay-CA, Long Beach-CA, Cerritos-CA

The Managed Care Clinical Pharmacist is a licensed pharmacist with a Doctor of Pharmacy degree and an American Society of Health Systems Pharmacist accredited residency. This is an exciting position with tremendous opportunity to improve systems of care for people with chronic and complex medical conditions.

This position is approximately 40% analytics and 60% Managed Care

responsibilities with emphasis on Medicare Part B utilization review and authorizations.

Responsibilities may include, but are not limited to :

  • Update and build the Part B program by identifying new medications to include in the catalog of pharmacist-reviewed medications

  • Work collaboratively with internal and external stakeholders on Cost of Care on pharmaceutical for Part B and Part D

  • Work within the Case Management and Utilization Management teams to provide recommendations for selection of appropriate, cost-effective medications

  • Utilize healthcare databases to provide pharmacy reports and analyses necessary to improve and track quality of care, utilization, and/or cost management initiatives

  • Design and implement strategic projects to improve access, quality, and efficiency of pharmacy services

  • Participate in the improvement of pharmacy-related STAR and HEDIS measures

  • Participate in the development of educational lectures and materials for CareMore clinical staff and patients

  • Answer inquiries from physicians and nurse practitioners regarding clinical appropriateness, current guidelines, and new drugs

  • Answer inquiries from sales team, and members related to formulary and prescription benefit

  • Support pharmacy initiatives to improve quality outcomes and lower medication cost to members and organization.

  • Understand and present reports on drug utilization and cost to providers and regional management

  • Assist the formulary planning team in selection of products

  • Provide analysis of rebate effects from formulary decisions

  • Ensure projects adhere to work plans and timelines

  • Assist the Residency program director in selecting and training new residents

  • Adhere to all CMS policy and procedures

  • May provide direct care to patients in clinic to initiate and prescribe new drug therapy, adjust, monitor or discontinue existing therapy under approved protocol for selected disease states including diabetes, CHF, COPD, hypertension, and hyperlipidemia

  • May work collaboratively with an interdisciplinary team to provide pharmaceutical care to members by conducting Comprehensive Medication Reviews (CMR) for polypharmacy, drug allergies, clinical effectiveness, cost effective drug selection, dose optimization, contraindications, adverse effects, potential drug interactions, therapeutic outcomes and adherence.

  • May review medication regimen with patient, in person or telephonically, through the MTM program

  • Ensure compliance with state, federal, and NCQA regulations

  • Some local travel required

  • Minimal supervisory duties

Education Required :

  • Doctor of Pharmacy (PharmD)

  • Masters in Health Administration (MHA), Masters in Business Administration (MBA), or Masters of Science (MS) degree

  • Residency in Managed Care (PGY 1)

  • CA Board of Pharmacy Pharmacist License

Experience Required :

  • 3-5 year previous pharmacy experience

  • Strong clinical, qualitative, quantitative, and communication skills.

  • Excellent written and oral communication skills

  • Proficiency with Microsoft Office tools including Word, Excel, PowerPoint

  • Experience using large databases to mine and analyze healthcare data

  • Strong interpersonal communication skills with the ability to effectively work with staff at all levels of the organization

  • Experience in a healthcare setting such as an HMO/health plan/IPA or other managed care setting

  • Prior managed care experience with Medicare at a health plan

  • Experience working with special needs populations (i.e. those with disabilities, multiple chronic conditions, etc)

  • Experience in drug utilization review

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

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