IFP Care Navigator - Clinical Pharmacist - Remote (Part-Time 30 hrs per week)

Position Scope

Care Navigators are healthcare professionals, who serve as customer advocates to coordinate, support, and guide care for our customers and families.

Additionally, the candidate will be responsible for the adoption and demonstration of the Care Solutions cultural beliefs. They will be responsible for role modeling the six cultural beliefs to drive personal accountability and organizational results.

• Customer Strong: I deliver world-class experiences for all my customers.
• Me to We: I take accountability to trust, partner, and deliver.
• Own It: I see a need and deliver value because I care.
• Evolve and Adapt: I learn and adapt to meet evolving business needs.
• Be Bold: I pioneer and think broadly to solve challenges.
• Take Care: I prioritize self-care and act with compassion toward colleague.

Day in the Life Responsibilities

• Reviews pharmacy data to extract market and member trends to develop targeted interventions.
• Navigation of multiple analytical programs and clinical systems that will provide data to improve clinical and financial outcomes and support trend management.
• Collaborates with case management, behavioral clinician, Medical Director, and member's provider to provide whole-person health support.
• Participate and collaborate in an innovative, targeted program that drives improved outcomes for a high-needs population.
• Perform targeted evaluations of available customer health records and using evidence-based medicine, educate and engage customers in successfully managing their drug regimen and chronic conditions.
• Establish credibility as a trusted partner and advisor to our provider partners, including interventions and recommendations to address quality measures and other clinical pharmacy concerns based on evidence-based protocols and guidelines.
• Assists in driving customer to cost effective treatments, including brand-to-generic medication utilization.
• Close gaps and barriers to medication adherence and assisting customers with compliance of 90-day refill rates versus 30-day, driving utilization of home delivery through pharmacy benefits manager (PBM).
• Provides clinical consultation and drug information to matrix partners and navigator team:
  • General medication questions
  • Medication regimen reviews/consultations
  • Medication reviews for polypharmacy
  • Safety concerns
  • Medication adherence
  • Gaps in care
  • Adherence to evidence-based treatment guidelines
  • Drug information (side effects, interactions, etc.)

• Interfaces with the customer, family members/caregivers, providers, and internal partners to coordinate the needs of the customer through telephonic, email, text, and chat interactions.
• Participates in rapid-cycle improvement processes with daily work/focus shifting to meet member trends.
• Tracks daily activities to trend volume and outcomes.
• Follows standard operating procedures.
• Toggles between multiple systems and applications.
• Prioritizes work to meet commitments aligned with organizational goals.
• Understands and adheres to organizational performance measures to deliver on key results.
• Completes training within the communicated time limit as required per role.
• Demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
• Proactive, nimble, and problem solving to resolve immediate customer needs.
• Assesses for, and facilitates resources, to aid/assist with Social Determinants of Health needs.

Minimum requirements:

• Active, registered Pharmacist/PharmD in good standing in the state in which they reside.
• Minimum of 2-3 years of clinical pharmacy experience.
• Successful completion of an ASHP accredited pharmacy residency preferred

Preferred requirements:

• Board of Pharmacy Specialties (BPS) Certification preferred
• Highly evolved clinical pharmacy skills and/or clinical knowledge and application of chronic condition/population health management.
• Direct Managed Care Health Plan and/or Pharmacy Benefit Manager (PBM) experience
• Strong understanding of health disparities/SDOH and their impact on overall health outcomes.
• Previous experience with pharmacy quality HEDIS measures.
• Previous experience in Medicaid and/or Marketplace/Accountable Care plans.
• Expertise in specialty drug therapy management for high-cost and complex conditions.
• Previous experience with drug utilization trend/performance reporting and pharmacy benefit design and implementation
• Adapts approach in real time to match