Managed Care Pharmacy Resident JHP

Job Details

Job Description

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Participate in the formulary management process including identifying areas for opportunity formulating drug specific edits and completing and presenting the New Drug Review at the Pharmacy and Therapeutics Committee meetings. Complete drug use evaluations to identify areas for improving quality reducing overall healthcare costs increasing generic utilization and identifying fraud waste and abuse.
• Acquire information about the pharmacy benefit design.
• Understand the role of quality measures within the pharmacy departments clinical programs.
• Participate in various Pharmacy clinical program meetings and initiatives such as those related to STARs HEDIS and Quality measures.
• Conduct outreach to members providers and pharmacies related to STARs HEDIS and Quality measures.
• Increase medication adherence close care gaps and to help members and collaborate with different health care professionals to optimize member outcomes.
• Oversee the development and maintenance of disease state initiatives as they relate to medication adherence.
• Assist in report generation and data management as it relates to disease state initiatives and quality measures.
• Participate in interdisciplinary initiatives within the health plan to support quality improvement.
• Support the pharmacy team in provider practice/health system initiatives to increase quality performance at the health plan.
• Learn about the Restriction Program Medication Therapy Management and the Specialty Pharmacy Network.
• Review pharmacy authorization requests for medical necessity determination. Render a coverage decision based on clinical evidence and criteria guidelines.
• Contribute to the development of clinical criteria for determining drug coverage decisions based upon clinical evidence.
• Under the direction of a Pharmacy Clinical Programs team pharmacist the resident will help to manage introductory and advanced practice pharmacy students.

CORE LEARNING EXPERIENCES

• Examples of Learning Experiences
  • Pharmacy Systems/Operations
  • Medicaid/CHIP Line of Business
  • Medicare Line of Business
  • ACA Lines of Business
  • Formulary Management and Drug Utilization Review
  • Pharmacy Benefit Design
  • Clinical Programs
  • Medication Therapy Management
  • Specialty Pharmacy
  • Prior Authorization Review
  • Prior Authorization Criteria Development
  • Data Analysis
  • Teaching and Mentoring

REQUIREMENTS:

Education:

• Graduate of an ACPE-accredited college of pharmacy

Certification/License:

• Licensed Pharmacist in the state of Pennsylvania or it is mandatory for the individual to have a Pharmacist license in the state of Pennsylvania by September 30th of the residency year by successfully passing the North American Pharmacist Licensure Examination (NAPLEX) and Multistate Pharmacy Jurisprudence Examination (MPJE) Pharmacy law exam

Experience:

• Completion of all practice hours as required for licensure

Knowledge Skills & Abilities:

• Strong clinical pharmacy skills required
• Excellent verbal interpersonal and written communication skills
• Ability to work independently as well as in a team environment to analyze data and provide feedback
• Knowledge of MS Word MS PowerPoint and MS Excel
• Ability to navigate Windows OS and other related programs
• Must have excellent organization and time management skills to execute multiple tasks and projects
• Able to work in a constant state of alertness and safe manner
• Access to working stable internet and a private quiet workspace
• Competent in communication with health care professionals and members
• Compliant with HIPPA and other company policies
• Competent in following and understanding workflows
• Competent to make member/patient medication adherence outreach calls
• Competent in discussing goals and writing basic notes with pertinent information
• Ability to locate interpret and implement current guidelines about the management of disease states

REQUIRED DOCUMENTS:

• Letter of Intent
• Resume/Curriculum vitae
• Two letters of recommendation

Work Shift

Worker Sub Type

Employee Entity

Primary Location Address

Nationally ranked Jefferson which is principally located in the greater Philadelphia region Lehigh Valley and Northeastern Pennsylvania and southern New Jersey is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65000 people strong dedicated to providing the highest-quality compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrows professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic clinical and applied research. Thomas Jefferson University home of Sidney Kimmel Medical College Jefferson College of Nursing and the Kanbar College of Design Engineering and Commerce dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8300 students. Jefferson Health nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age race color religion creed sexual orientation gender gender identity marital status pregnancy national origin ancestry citizenship military status veteran status handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues including medical (including prescription) supplemental insurance dental vision life and AD&D insurance short- and long-term disability flexible spending accounts retirement plans tuition assistance as well as voluntary benefits which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues including those who work less than part-time(including per diemcolleagues adjunct faculty and Jeff Temps) have access to medical (including prescription) insurance.

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