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.