Quality Improvement Clinical Pharmacist I

Summary

Job Description:

The Quality Improvement Clinical Pharmacist position participates in a wide range of provider and patient initiative programs. The overall goal of the position is to work collaboratively within the department, division and across the organization to help drive quality improvement in all Lines of Business (LOB). Unique programs or initiatives may be specific to a LOB or focus on the entire health plan population. The Pharmacist works collaboratively with others as a member and representative of an interdisciplinary quality team that can be LOB specific or targeting the entire health plan population.

Medicare Focus

The primary responsibility for the Medicare LOB will be to support internal staff and oversee external vendors that perform Comprehensive Medication Reviews (CMRs), Targeted Medication Reviews (TMRs), as well as develop programs that support these efforts. Additionally, the pharmacist will be part of an interdisciplinary team that is focused on STAR improvement for Part C and Part D measures.

Medicaid Focus

The primary responsibility for the Medicaid LOB will be to work collaboratively with the Health Care Improvement team on QARR measures. They will act as the subject matter expert as it relates to drug therapy and quality improvement. Additionally, they will support other departments that focus on the quality of care that our members receive. They may participate in cross-functional teams that look at prescribing habits of physicians or overutilization of services by our members.

Essential Primary Responsibilities/Accountabilities

Level I:

• Work with leadership to develop clinical programs that focus on quality measures that are industry standard metrics such as QARR, STARs, HEDIS, PQA and others.
• Develop written documents for members and providers regarding drug therapy strategies such as inappropriate use, over/under utilization, gaps in care, etc.
• Conduct telephonic consultations with our members regarding their drug therapy and disease states
• Provides disease specific educational materials and self-monitoring devices, as appropriate.
• Participates in the core Pharmacy Quality Strategy meeting to help maintain and improve the program
• Works in matrix collaboration with other departments including Health Care Improvement, Communications, Provider Relations, Customer Care and Medical Services
• Oversee and monitor CMS requirements for the Opioid Drug Management Program
• Provides comprehensive support directly to both providers and pharmacies.
• Provides guidance, instruction and mentoring of pharmacy and other health care students involved in experiential rotations in the department.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.
  
  

Level II (in Addition To Level I Essential Responsibilities/accountabilities)

• Understand Line of Business (LOB) differences and similarities and be able to handle cross functional responsibilities outside of their own primary LOB
• Collaborate with the pharmacy strategy team to drive quality improvement through drug formulary alignment
• Works independently in coordinating and collaborating with members and providers, resulting in improving member and community health
• Engage with our Accountable Cost and Quality Agreements (ACQA) entities to develop unique programs that support our quality improvement projects
• Offers process improvement suggestions and participates in the solutions of more complex issues/activities as it relates to both internal programs and the work that our vendors perform.
• Be the team lead on projects and develop charters that include an AIM statement, appropriate outcome and process measures, tracks progress and are able to present the results to appropriate committees.
• Displays leadership and serves as a positive role model to others in the department.
• Develops new methods of engaging members to become more involved in their drug regimen and overall health. Serves as a resource to internal and external customers for specific therapeutic topics where the clinical pharmacist is considered a content expert.
• Trains new staff on MTM software and provides education to them regarding CMS MTM requirements and Star measures.
  
  

Minimum Qualifications

NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

All Levels

• Current New York State Pharmacist with doctoral level (Pharm.D) degree and a minimum of two years of experience in an organized health care setting. In lieu of degree, a Bachelor’s degree (BSRPh) and a minimum of two years of experience in an organized health care setting will be considered.
• Excellent verbal and written communication skills with experience communicating with patients (our members) and health care professionals.
• Knowledge and skill to conduct a thorough drug regimen review. Strong clinical knowledge base, kept current through continuing education and professional affiliations.
• Maintains confidentiality and uses only the minimum amount of protected health information (PHI) necessary to accomplish job related responsibilities.
• Strong computer skills. Proficient knowledge of Microsoft Word and Excel. Ability to learn new systems.
• Basic knowledge of CMS minimum standards for MTM services is desired.
  
  

Level III (in Addition To Level I Minimum Qualifications)

• Minimum of five years of clinical pharmacy experience including participation in patient management initiatives.
• Prior accountability for implementation of a new program or initiative that focused on quality improvement or member/provider engagement
• Additional certification in a specialized area such as Geriatric Pharmacy, Pharmacoeconomics, or Medication Therapy Management is preferred.
• Advanced knowledge of CMS requirements and standards for MTM services.
• Advanced knowledge of the variety of quality measures that have a direct impact on Health Plan performance
• Proficient knowledge of Power Point and past experience presenting to large cross functional groups with a diverse background (business, finance, clinical, etc.)
  
  

Physical Requirements

• Ability to travel frequently across New York State and neighboring areas is required.
• Some travel required out of area. Must have ability to travel.
  
  

The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.

Our Company Culture

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s)

Level I: Grade 210: Minimum $85,446 - Maximum $158,080

Level II: Grade 210A: Minimum $99,133 - Maximum $183,394

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Salary : $183,394