Employment Spot

Job Description

About Us

Community Health Plan was established in 1992 by a network of community health centers across Washington State. We provide coverage for people in 33 counties (see our clinic site list). Our members receive services from more than 1,000 primary care providers and 8,000 specialists at more than 250 primary care sites and over 80 hospitals. We're the fifth-largest health program in Washington (commercial or non-profit).

Key Relationships

Reports To: AVP of Pharmacy

Supervises: None
Other Key Relationships: Clinical Pharmacist, Pharmacy Technician, Care Management

FLSA: Non-Exempt

Position Purpose

The clinical pharmacist will support pharmacy initiatives to ensure appropriate medication use, and evidence-based formulary management, Medicare Part D compliance.

Responsibilities of Clinical Pharmacist

Principle Duties

• Performs clinical reviews for over-ride requests and appeals
• Serves as a drug expert who will provide clinical consultation to Community Health Plan internal (care management) and external customers
• Perform clinical in-service to Community Health Plan internal customers
• Develops and implements evidence-based pharmacy intervention programs
• Completes research and prepares evidence-based clinical protocols, and prescribing guidelines
• Develops and manages the formulary, including the review and presentation of new drugs and therapeutic classes to the Pharmacy and Therapeutics Committee.
• Develops medication treatment guidelines for clinical use
• Develops provider and member communication materials
• Monitors activities performed by Community Health Plan’s pharmacy benefit manager to ensure compliance to regulatory, contractual and accreditation requirements
• Develops policy and procedures for pharmacy benefit management
• Monitors utilization and cost trend and identifies intervention opportunities
• Monitors, identifies and addresses potential fraud, waste and abuse activities in pharmaceutical
• Details provider groups regarding adverse drug utilization trend to ensure appropriate medication use.
• Other duties as assigned.

Job Requirements

Requirements for Clinical Pharmacist

Qualifications

Education

• RPh licensure with advanced clinical pharmacy training or
• Pharm D with clinical residency.
  

Prior Related Experience

• 5 plus years of experience with managed care drug therapy, including drug utilization review, formulary development, academic detailing and/or pharmacoeconomics.

Employment Eligibility:

• Candidate has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.

Knowledge, Skills, and Abilities

• Strong clinical skills and knowledge of formulary management and clinical program development.
• Ability to manage multiple, complex, concurrent projects
• Strong analytical skills
• Strong project coordination skills
• Excellent written and verbal communication skills.
• Excellent organizational and planning skills
• Ability to work as a team member as well as independently.
• Self-starting and highly self motivated
• Strong PC operation skills that include but not limited to Word, Excel, Visio, Access and PowePoint.
• Strong interpersonal skills.
• Ability to travel as necessary.
  
  

Sensory / Physical / Mental Requirements

Sensory:

• Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical:

• Extended periods of sitting, computer use, talking and possibly standing.
• Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion.
• Frequent torso/back static position; occasional stooping, bending and twisting.
• Some kneeling, pushing, pulling, lifting and carrying (not over 25 pounds), twisting and reaching.
  

Mental:

• Must have the ability to learn and prioritize multiple tasks within the scope and guidelines of the position and its applicable licensure requirements, many requiring extremely complex cognitive capabilities.
• Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.

Candidates whose disabilities make them unable to meet these requirements will still be considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

Work Environment

Office environment with frequent environmental exposure to low-grade radiation from computer monitors; fast paced with frequent interruptions.

Protected Health Information (PHI) Access

Community Health Plan employees will encounter protected health information in the regular course of their work at and for Community Health Plan. Community Health Plan is a Covered Entity engaging in Health Care Service Contractor treatment, payment and operations. The following scale intends to provide some indication of how often the employee may encounter or work with PHI in this particular role. All PHI shall be used and disclosed on a Need To Know Basis and according to HIPAA Privacy Rules Part 164. In addition, every employee shall sign a confidentiality agreement as a condition of employment and violation of that agreement and/or Community Health Plan policies can be cause for termination.

PHI is defined at 164.103 as:

"Protected health information means the individually identifiable health information that is

• Transmitted by electronic media
• Maintained in electronic media
• Transmitted or maintained in any other form or medium.

Individual means the person who is the subject of protected health information.
Individually identifiable health information is information that is a subset of health information, including demographic information collected from an individual, and:

• Is created or received by a health care provider, health plan, employer, or health care clearinghouse; and
• Relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual; and
• That identifies the individual; or
• With respect to which there is a reasonable basis to believe the information can be used to identify the individual.

This position as described will use, encounter, read, create, disclose and or work with in general, PHI that is created by or received by Community Health Plan:

• Frequent - The position has frequent and/or daily access and responsibility for PHI. Need to know.

In all cases, PHI use and disclosure is limited to the minimum necessary amount of PHI needed to complete the treatment, payment or operations.

The above is intended to describe the general content of and the requirements for satisfactory performance in this position. It is not to be construed as an exhaustive statement of the duties, responsibilities or requirements of this position.