Clinical Pharmacist

Apply on line at http://www.alohacare.org/Careers/Default.aspx

The Company:

AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.

The Culture:

AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.

AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.

These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.

The Opportunity:

The Clinical Pharmacist is an integral part of the AlohaCare Clinical Pharmacy team and will work to drive pharmacy initiatives and clinical programs within the QUEST Integration and Medicare lines of business. The Clinical Pharmacist will research, develop, and update drug utilization management strategies and work to promote clinically appropriate prescribing practices which adhere to AlohaCare formulary, regulatory guidelines, and national clinical practice guidelines; the position will interact frequently and independently with Plan members, prescribers, pharmacies, collaborative care team members, and with the PBM. General duties will include participation in pharmacy clinical programs, development of drug utilization criteria, review of prior authorizations and appeals, perform oversight functions, interface with plan members and prescribers to discuss drug therapy, and perform other projects and reports as assigned.

Primary Duties & Responsibilities:

• Generate and analyze claims and utilization reports to track general trends in drug utilization and to identify potential targeted utilization management activities.

• Develop and update drug utilization criteria.
• Proactively develop and maintain contacts and relationships with key providers to successful interaction and intervention activities.

• Utilize clinical and regulatory guidelines in the review of drug prior authorization and appeals requests.

• Maintain and develop the Drug Utilization Review (DUR) initiatives to promote the cost-effective use of medications.
• Assists in the preparation of drug monographs and utilization reports for Pharmacy & Therapeutics (P&T) Committee and DUR Board.
• Develop, implement, and maintain drug coverage criteria in close coordination with the P&T Committee.
• Interface with providers and internal AlohaCare departments on any pharmacy, formularies, drug use criteria, and/or the P&T Committee related process.

• Assists in updating AlohaCare Pharmacy policies and develops new policies and procedures when needed.

• Participate in medication review, disease state management, and other clinical quality improvement programs including but not limited to Medication Therapy Management (MTM), medication review, medication adherence outreach, retrospective drug utilization review (rDUR), Transitions of Care (TOC), and interdisciplinary care teams.
• Work with management to recommend, develop and implement target drug utilization intervention programs and other DUR/DUE activities.
• Assists in the clinical oversight of delegated functions including but not limited to prior authorization, MTM, and lock in programs, etc.
• Adhere to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures.
• Support the Medicare After-Hours Help Desk telephone as assigned by the Pharmacy Director.
• Other duties as assigned.
• Responsible to maintain AlohaCare’s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.

Required Competencies & Qualifications:

• Doctorate degree in Pharmacy.
• Active registered pharmacist license in the State of Hawaii.
• 3 years of experience in pharmacy
• Strong written and verbal communication
• Proficient in Microsoft (MS) Word, Excel, and PowerPoint.

Preferred Qualifications:

• 2 years of experience in managed care pharmacy.
• Basic understanding and use of MS Access and/or other database desired.

Physical Demands/Working Conditions:

• Inside working conditions.
• No environmental hazards.
• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

Salary Range: $112,000 to $140,000 annually

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.

Salary : $112,000 - $140,000