Clinical Pharmacy Consultant

Company:

Description:

We are seeking a talented individual to join our team at Mercer. This role can be based in Atlanta, Chicago, Denver, Houston, Los Angeles, Phoenix, Portland & San Francisco, and offers a hybrid work arrangement, requiring a minimum of three days per week in the office.

As a Clinical Pharmacy Consultant you will work as part of the clinical team responsible for assisting in the management of complex clinical cases that often result in evaluation of high- cost claimants and will serve as the pharmacy subject matter expert for internal and external clinical partners collaborating on cases and providing education on specialty medication management. The role requires a strong understanding of specialty medication products, site- of- care redirection, channel management, medical necessity and prior authorization criteria, utilization management strategies, complex disease management and an understanding of the pharmacy medication pipeline.

We will count on you to:

• Act as the specialty pharmacy resource for your assigned clinical team(s) to assist in the identification and management of potential and actual high cost claimants.

• Interpret pharmacy data reporting shared by the benefit administrators and leverage this information for selection of HCC cases for review.

• Participate in discussions with the benefit administrators’ clinical teams to identify strengths and opportunities in how the case is being managed and offer suggestions to shape the course of the member’s care moving forward.

• Work to create summary reports to Mercer H&B teams, coalition partners and/or clients in a clear and constructive manner.

• Participate in Pharmacy Practice meetings and ensure Mercer's point of view on effective pharmacy clinical management strategies is effectively communicated.

• Incorporate compliance and professional standards into all work processes, including transparency, peer review and maintaining required licensure.

• Monitor success of projects in terms of client satisfaction, scope, and timeliness of deliverables.

• Establish effective carrier/vendor relationships to represent Mercer and to serve our clients.

• Provide mentoring and coaching to team members on specialty medications and pharmacy management

• Assist in the development of ongoing training presentations, and other learning collaterals used to influence care outcomes and demonstrated ability to use various communication modes and tailor presentations of technical information to various audience levels

• Support wellness consulting projects by providing pharmacy subject matter expertise to cross-functional teams working in areas such as chronic conditions management, ensuring pharmacy insights meaningfully shape clinical and financial outcomes for our clients.

• Advance clinical program effectiveness by conducting pharmacy assessments to support Mercer’s clinical care management model across various managed care organizations.

• Assist with other consulting projects as needed.

• Thrive and be motivated by an environment that embraces AI and technology-enabled tools.

What you need to have:

• Active, unencumbered Pharmacy license.

• At least 7+ years relevant work experience in clinical pharmacy

• Ability to navigate MS Office Tools (Word, Excel, PowerPoint, Teams)

• Clinical acumen to evaluate specialty medication regimens, make evidence-based recommendations and suggestions to shape the course of the member’s care moving forward.

• Proven organizational skills with ability to prioritize and handle multiple tasks in a demanding work environment

• Strong communication skills with ability to share highly technical information in a non-technical fashion; strong business writing skills.

• Ability to partner and lead teams to produce client deliverables

• Ability to work independently and on a team

What makes you stand out:

• Pharm.D. degree from an accredited college of pharmacy

• Certified Specialty Pharmacy (CPS) with the National Association of Specialty Pharmacy

• Experience supporting infused specialty medications

• Experience in managed care settings

• Background in case management review of specialty medications, including site-of-care review

• Experience conducting prior authorization reviews

• Clinical payer (carrier)experience, including demonstrated clinical leadership

Why join our team: