Clinical Pharmacy Coordinator

This position is responsible for supervision of administrative and clinical aspects of the CCHP pharmacy benefit for Commercial, Exchange, and Medicare lines of business. The Clinical Pharmacy Coordinator will develop and maintain effective working relationships with pharmacy technicians, pharmacies and CCHP staff to ensure members receive optimal quality care and service. The pharmacist will work with CCHP’s PBM vendor and Compliance department to maintain regulatory compliance with state and federal authorities. The pharmacist manages the formulary and shall support and serve on the CCHP Pharmacy and Therapeutics Committee.

• Oversee the CCHP Commercial, Exchange, and Medicare Part D formularies. Monitor non- formulary drugs and make recommendations for additions or changes to the formulary.
• Monitor the impact of the formulary and prepare clinical reviews to recommend utilization guidelines and prior authorizations criteria, including strategies to decrease pharmacy costs for members and CCHP.
• Working with the Medical Department and PBM, develop prior authorization criteria, pharmacy benefit coverage recommendations and formulary alternatives.
• Contact physicians and pharmacies directly for quality assurance issues regarding pharmacologic standards of care and best practices. Collaborate with physicians on identified medication related issues and work with them to improve patient therapy.
• Maintain effective relationships with CCHP’s pharmacy network through regular communication to ensure efficient administration of the formulary for members and physicians.
• Issue overrides and assists pharmacies with authorization issues in accordance with formulary protocol.
• Participate in the quarterly Pharmacy and Therapeutics (P&T) Committee, which includes developing agenda items, presenting clinical drug information and serving as a member of the P&T Committee.
• Monitor and analyze prescribing patterns and drug usage. Report findings and recommendations to the P&T Committee.
• Monitor reports for members hitting coverage gap to assure that drugs are categorized as Part D correctly and resolve discrepancies with CCHP’s PBM.
• Perform audits of all prior authorizations performed by CCHP’s PBM.
• Audit Part B vs. Part D drugs to assure drugs and costs are applied to the correct benefit.
• Review, prepare, and assist in validating plan submissions to state and federal agencies
• Assure compliance with state and federal regulations regarding the pharmacy benefit.
• Work with CCHP nurses in the disease management/care management/utilization management programs by providing pharmacy data, expertise and tasks as assigned.
• Accepts and performs other duties as assigned.

Minimum required:

• B.S. Pharm or PharmD Degree
• Pharmacist with current unrestricted CA license (RPh)
• Completion of PGY-1 Pharmacy Residency (Managed care or Pharmacy Practice) OR minimum 2 years of managed care or clinical pharmacy experience
• Proficient in MS Office, particularly Word, PowerPoint, Excel
• Thorough knowledge regarding therapeutic use of drugs
• Ability to relocate or commute to San Francisco as job necessitates
• Authorized to work in US

Preferred:

• Pharmacist with demonstrated experience managing administrative and professional functions of a business unit
• At least 1 year experience managing pharmacy benefit (formulary and/or drug utilization management)
• Working knowledge of applicable state and federal regulations for Medicare, HMO Commercial Plans, and Exchange lines of business.
• Therapeutic knowledge of specialty pharmacy disease state management
• Excellent research and analytical skills with ability to apply evidence-based principles to physician prescribing and drug utilization.
• Previous experience with Pharmacy & Therapeutics committees and presentations.
• Ability to multi-task; composure to effectively handle multiple priorities and deadlines.

• Able to lift up to 30 pounds
• Use proper body mechanics when handling equipment
• Standing, walking and moving 50% of the day.

Complies with CCHP Compliance Handbook including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs.

Starting at $118,000 – $143,000 per year

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.