Under the direction of the Manager, Case Management works with members/providers to address and optimize members medication profiles. The associate will focus on assessing, and monitoring member’s drug therapies. The associate identifies issues, makes recommendations works with the health care team and implements interventions. The Clinical Pharmacist facilitates communication and serves as a liaison and educator between the member, family, the Plan, and all members of the health care team, thus promoting high quality, cost-effective services.
Duties And Responsibilities
Responsible for evaluating members entire medication profile and optimizing member’s drug therapy
- Appropriately contacts and assesses the member to identify and resolve medication gaps
- missing medication and affordability issues
- prior auth issues and appeals
- Address Polypharmacy and works to reducing the number of medications to increase adherence.
- The associate optimizes the member’s benefit by promoting effective and efficient use of health care / Pharmacy resources.
- Address inappropriate/missing medications
- Educate on benefits, formulary
- Routinely provides members with proper information for the safe and effective use of medications
- Drug therapy optimization, ensuring proper drug dosage and cross-drug utilization
- Improve medication adherence
- address patient/family concerns/questions, and provide education on pharmacotherapy
- Adverse side effect mitigation
- Drive towards most cost-effective medications
- Reduce pharmacy and medical spend
- Coordinate recommendations with nurse health coach and member’s providers
- Monitors the effectiveness of the Medication plan and documents interventions and follow-up
- Accurately documents within the manage care system, utilizing appropriate standard templates and identifies themselves as the Clinical pharmacist working with the member.
- The associate develops a strong understanding of community resources with may be recommended to support the member/family beyond the Plan’s benefit parameters
- The associate provides exceptional customer service to all internal and external customers.
- Maintains current knowledge necessary to provide pharmacy services of the highest standards
- Other duties as assigned
Qualifications - External
Required Qualifications:
- Doctor of Pharmacy or Bachelor of Science Degree in Pharmacy plus 1-3 years of relevant clinical experience
- Active State Pharmacy License
- At least 5 years practice experience or accredited Managed Care Residency
Preferred Experience
- Current knowledge and expertise in clinical pharmacology, disease management and managed care
- Experience with team-based care
- Self-management Skills – self-motivated, organized, detail oriented and manages time and resources effectively. Must be able to work independently in a collaborative environment, be self-directed and possess excellent organizational and time management skills
- Computer/Technology Competency: Proficient in use of Microsoft Word, Excel, and Outlook
Fully Remote
This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence’s physical office locations to perform the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
