Clinical Services Pharmacist Consultant

What you’ll do:

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

The Clinical Services teams are part of our Pharmaceutical Benefits operations organization and are vital in providing core services for medication therapy management pharmacy, therapeutics committee, provider education and coverage determination.  This critical team ensures our high standard of quality services are provided to clients and beneficiaries.

As our Clinical Services Pharmacist Consultant you will be key in the evaluation of coverage determination requests and in the development and execution of clinical programs designed with the major goal of improving health-related outcomes for our client’s beneficiaries. You will work in a few areas across the Clinical group with the goal of optimizing the use of medication, promoting health, wellness, and disease prevention among our clients’ beneficiaries through comprehensive and targeted medication reviews to identify, resolve, and prevent medication-related problems.

The fundamentals for the job…

• Perform comprehensive and targeted medication reviews to identify, resolve, and prevent medication-related problems and document the care delivered.
• Provide clinical recommendations using prescription and medical claims data and client formulary information.
• Make recommendations regarding gaps in care, high risk medications, drug interactions, therapeutic and generic substitution, compliance and adherence, among others Communicate essential information to beneficiaries’ primary care providers.
• Work with the Health Educator and Case Managers to ensure Medication Therapy Management (MTM) and other clinical programs participants are receiving all the necessary and relevant information.
• Evaluate, analyze, and look for methods to streamline processes to ensure improved patient care, outcomes, and program quality.
• Work with cross functional teams to plan and execute clinical projects, operationalize formularies and medication lists, and deliver the highest quality of service to clients and partners.
• Support Centers for Medicare & Medicaid Services (CMS) STAR initiatives, Medicaid’s Health Care Improvement Program and other clinical programs.
• Participate in government and internal audits, and in the Pharmacy & Therapeutics Committee, preparing presentations and clinical recommendations.
• Develop and document Clinical Policies and Procedures.
• Evaluate coverage determination requests, ensuring that all coverage determinations and appeal responses are clinically appropriate and compliant.
• Assist in providing clinical support, including drug information to the physician assistant (PA) Customer Service Teams, to ensure appropriate clinical decisions are made for beneficiaries, before, during, and after point of sale.
• Ensure compliance with Centers for Medicare & Medicaid Services (CMS) and Utilization Review Accreditation Commission (URAC) in all clinical processes executed.

What we expect of you:

The bold requirements…

• Pharmacy Degree (PharmD or RPh) required.
• Current/ active Pharmacy License from Puerto Rico.
• 3+ years of experience working with clinical operations, clinical programs or medication therapy management.
• Excellent oral and written communication skills, bilingual Fluency in Spanish and English is required for this role.
• We are proud to offer a flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only).

Nice to haves…

• Experience working in pharmacy benefit management (PBM) industry.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant m