Population Health Clinical Pharmacist NE

Primary City/State:

Mesa, Arizona

Department Name:

Banner Staffing Services-AZ

Work Shift:

Day

Job Category:

Pharmacy

Pharmacy careers are better at Banner Health. We are committed to developing the careers of our team members. We care about you, your career today and your future. If you’re looking to leverage your abilities – apply today. 

As a Population Health Clinical Pharmacist, you wil use clinical knowledge to review medication prior authorization requests against set clinical criteria. You will also review chart notes and labs from providers to ensure criteria have been met or should be denied. You'll be expected to select appropriate letter and/or fax template to notify providers/members of decision and/or request additional information and you must document all decisions following standard template. You may interact with providers (and rarely members) for additional information and/or to provide education about criteria

Shifts may vary between 4-8 hours, Monday – Friday 8am – 5pm (AZ time). You will have at least 2 shifts per month but may have more based on business need. No weekend or on-call rotation.

Banner Staffing Services (BSS) offers Registry/Per Diem opportunities within Banner Health. Registry/Per Diem positions are utilized as needed within our facilities. These positions are great way to start your career with Banner Health. As a BSS team member, you are eligible to apply (at any time) as an internal applicant to any regular opportunities within Banner Health.

As a valued and respected Banner Health team member, you will enjoy:

• Competitive wages

• Paid orientation

• Flexible Schedules (select positions)

• Fewer Shifts Cancelled

• Weekly pay

• 403(b) Pre-tax retirement

• Employee Assistance Program

• Employee wellness program

• Discount Entertainment tickets

• Restaurant/Shopping discounts

• Auto Purchase Plan

Registry/Per Diem positions do not have guaranteed hours and no medical benefits package is offered. Completion of post-offer Occupational Health physical assessment, drug screen and background check (includes; employment, criminal and education) is required.

POSITION SUMMARY
This position supports all aspects of pharmacy services within the Banner Health Insurance Division, including utilization management, care management, and pharmacy quality responsibilities. This position drives optimal member experience, provider experience, and financial performance through assigned areas of work. Incumbents maintain a high degree of clinical acumen, and leverages strong organizational, communication, and execution skills to ensure the successful deployment of pharmacy benefits across all populations. This role is highly independent, and incumbents work across departments, and with internal and external stakeholders.

CORE FUNCTIONS
1. Provides management of pharmacy services to Insurance Division members, including commercial, Medicare, Medicaid populations within owned/operated health plans as well as value-based agreements. Identifies and stratifies members based on complex pharmaceutical care needs to optimize pharmacotherapy regimens at the patient/member level, and population level to improve overall healthcare quality and reduce costs that is consistent with acceptable standards of pharmacy practice and CMS Medicare Part D regulations and guidance. Analyzes and interprets pharmacy and medical claims reporting and other sources of clinical and economic data to generate insights and clinical service opportunities.

2. Active participant and/or leader in defining, implementing, and managing clinical programs and services that improve pharmaceutical care quality and lowers costs in all Insurance Division lines of business. Programs include but are not limited to, medication therapy management, pharmacy quality measure performance, utilization management, member outreach and engagement, provider education and detailing, drug utilization reviews, or formulary monograph development.

3. Maintains proficiency in all legal, regulatory, and practice standards related to CMS, AHCCCS, or out-of-state Medicaid programs. Maintains proficiency in all pharmacy related URAC, NCQA, or other applicable accreditation standards. Maintains clinical proficiency in assigned clinical area(s) through continuing education.

4. Conducts utilization management reviews and adjudicates prior authorization requests and appeals. Participates in multidisciplinary appeals and grievances reviews as assigned. Takes ownership to identify and resolve utilization management issues and promotes a