Pharmacy Clinical Program Manager in Portland, OR

Cambia Health Solutions in Portland, OR

  • Industry: Scientific Research - Health/Medicine/Pharmacology
  • Type: Full Time
  • $32,190.00 - 42,440.00
position filled
Responsibilities & Requirements The Pharmacy Clinical Program Manager is responsible for developing, executing, evaluating and maintaining clinical programs and strategies to support cost containment and clinical quality improvements related to pharmacy. Collaborates with internal stakeholders to ensure alignment with care management, provider engagement, and member engagement strategies. Partners with pharmacy clinical staff to support the execution of drug formulary, medication policies, utilization management, and quality initiatives as they pertain to clinical programs components. Supports cost stewardship initiatives, opioid management initiatives, HEDIS/Stars/QRS improvement initiatives, vendor management and other priorities and focus areas identified to meet market, business and health plan needs. Responsibilities: Lead the identification of clinical areas for product development Lead the development and execution of clinical programs to meet clinical, market, and member needs, including clinical pilots with strategic partners Maintain competitive industry knowledge of market differentiating clinical strategies Analyze utilization trends and quality outcomes performance and provide creative solutions to support cost containment, quality improvement and regulatory compliance needs Assess, critique and select vendor clinical offerings most suited for Regence clinical and business goals Negotiate, monitor and manage vendor performance, manage inter-departmental coordination to ensure alignment of strategic goals and streamlined member experience Participate in pharmacy clinical strategies development, provide input for formulary development, policy development, benefit design and utilization management initiatives Evaluate, document and manage clinical product offerings on a regular basis to maintain a competitive product portfolio with strong ROI Design and improve clinical and operational processes to support strong and consistent delivery of top notch member experiences and operational efficiency Provide consultative expertise for strategic provider partners, plan leadership, purchasers, Quality Incentive Plan participants, contracted pharmacy partners and other Health Plan stakeholders as needed Partner with departments external to pharmacy to promote integration of clinical services and provide holistic member care. Mentor, coach and evaluate pharmacy students and residents. Minimum Requirements: The Pharmacy Clinical Program Manager would have a Bachelor's degree in a health related field and four years of experience in ambulatory care/hospital/pharmacy benefit management. Pharm.D. degree and experience in pharmacy benefit management and clinical program development is preferred. Strong knowledge and understanding of the pharmacy benefit management industry, benefit design, pharmacy products and services, and knowledge of competitive offerings, as well as the needs of clients. Strong knowledge of health care economics and financing; health care/pharmaceutical industry dynamics; and pharmacy/provider service reimbursement of medications. Demonstrated strong clinical knowledge and understanding of practical application of evidence-based medicine principles to formulary design, medication coverage policies, and other medication management solutions. Demonstrated ability to interpret complex clinical information, claims data and regulatory requirements to deliver practical and creative product development solutions. Demonstrated leadership and interpersonal skills and ability to effectively manage projects and vendor relationships. Demonstrated success in managing professional business relationships in a managed care system, medical group, hospital, or related business in health care delivery industry. Excellent verbal and written communication skills; strong business analytical skills and abilities; strong project management and coordination ability. Knowledge of: Health Plan and benefit design structures and application; Medicare/CMS regulations and applicability in administering the Exchange and Medicare Products; Pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; health care coding and payment systems (such as ICD-10, CPT, HCPCS, NDC); state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA; Compliance related activities, legislative and regulatory activities, health insurance operations, or legal research helpful.Salary Range: NAMinimum QualificationLess than 5 years
Associated topics: aseptic technique, biomedical, immunology, injury, microbiological, nutritionist, pharmacology, protein, therapeutic, virus

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