Managed Care Pharmacy Resident - JHP

Jefferson Health Plans • Jefferson Township, PA

7d

About The Position

The managed care resident, following the completion of the PGY1 managed care pharmacy residency program, will be competent in several practice areas within managed care pharmacy such as pharmacy systems/operations, formulary management, drug utilization review, prior authorization review, prior authorization criteria development, and clinical programs. The knowledge that the resident will acquire in patient care, leadership, and education skills will prepare the resident for board certification, postgraduate year two (PGY2) pharmacy residency training, and other future endeavors beyond the PGY1 managed care pharmacy residency program.

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

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 department’s 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.

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 diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

What This Job Offers

• Job Type: Part-time
• Career Level: Entry Level
• Education Level: No Education Listed