Managed Care Pharmacy Resident

Job Details

Job Description

Summary/Objective:

The Managed Care Resident, following the completion of the postgraduate year one (PGY1) managed care pharmacy residency program, will be competent in several practice areas within managed care pharmacy such as pharmacy clinical programs for all lines of business aligning with corporate and regulatory financial and quality goals, pharmacy systems/operations, formulary management, drug utilization review, prior authorization review, and prior authorization criteria development. The knowledge that the resident will acquire in patient care, leadership, and education skills will prepare the resident for board certification, postgraduate year two (PGY2) pharmacy residency training, and other future endeavors beyond the PGY1 managed care pharmacy residency program. Documents required for consideration for this position include the following: Letter of Intent, Curriculum Vitae, and one letter of recommendation.

Essential Functions:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Able to work in a constant state of alertness and safe manner.
• Participate in the formulary management process including identifying areas for opportunity, formulating drug specific edits, and completing and presenting the New Drug Review for both Medicaid and Medicare lines of business at the Pharmacy and Therapeutics Committee meetings. Complete drug use evaluations to identify areas for improving quality, reducing overall healthcare costs, and increasing generic utilization.
• Acquire information about the pharmacy benefit design.
• Participate in various clinical program meetings and initiatives.
• Learn about the restriction program, Medication Therapy Management, and Specialty Pharmacy Network.
• Review pharmacy authorization requests for medical necessity determination. Render a coverage decision based on clinical evidence and criteria guidelines.
• Contribute to the development of clinical criteria for determining drug coverage decisions based upon clinical evidence.
• Under the direction of the Manager of Pharmacy Clinical Programs, the resident will supervise advanced practice pharmacy students during their managed care rotations
• Review members' medication profile and apply evidence-based medicine and national guidelines when creating recommendations to health care providers for optimizing the members' medication regimen.
• Assists in coordination of care for pharmacy-related issues between providers and other members of the member's interdisciplinary care team.
• Assist in executing programs developed in coordination with quality team to support HEDIS, STARs, and other quality initiatives related to pharmacy and company goals.
• Support initiative activities, pilot programs and measure performance, design strong improvement interventions, measure effectiveness of programs to company goals
• Actively engage and participate with member care team meetings to meet and comply with CMS and DHS requirements (e.g. rounds, ICT interdisciplinary care team, STARs, pay for performance and HEDIS quality measures).
• May perform other duties as assigned.

Required Education and Experience:

• Graduate of an ACPE-accredited college of pharmacy.
• Licensed Pharmacist or eligible for licensure.
• Completion of all practice hours as required to be eligible for licensure.

Skills/Abilities:

• Strong clinical pharmacy skills required.
• Excellent verbal, interpersonal, and written communication skills.
• Ability to work independently as well as in a team environment to analyze data and provide feedback.
• Competency with MS Word, MS PowerPoint and MS Excel.
• Good presentation skills.
• Excellent organization and time management skills to execute multiple tasks and projects.

Work Shift

Worker Sub Type

Primary Location Address

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.