Clinical Pharmacist – Cost Containment

This is a fully remote position, open to applicants in Washington.

📋 Description

• Deliver clinical pharmacy expertise to aid in the development, implementation, and ongoing management of cost containment initiatives.

• Assess prescription drug usage, prescribing behaviors, formulary options, and emerging therapies to pinpoint potential savings.

• Create and enhance programs that encourage clinically suitable, cost-efficient medication usage.

• Analyze new program opportunities for clinical relevance, operational viability, financial implications, and member impacts.

• Investigate medication disruption and transition opportunities for new business members.

• Address physician and member inquiries and appeals regarding the clinical suitability of drug or pharmacy alternatives.

• Provide continuous clinical support for designated programs, encompassing setup, implementation, maintenance, and ongoing enhancement.

• Develop and uphold clinical criteria, workflows, documentation, and operational guidelines.

• Resolve intricate clinical queries, exceptions, and escalations.

• Identify workflow deficiencies, minimize manual processes, and enhance program efficiency.

• Monitor program outcomes and pinpoint opportunities to bolster effectiveness, consistency, and scalability.

• Analyze drug usage, claims trends, prescribing behaviors, and associated data.

• Evaluate program performance and confirm savings opportunities in collaboration with Analytics, Finance, and stakeholders.

• Establish program metrics, reporting tools, and performance dashboards.

• Review outcomes, identify trends and unforeseen results, and suggest modifications.

• Document program value and convey clinical and financial outcomes to stakeholders and clients.

• Collaborate cross-functionally with Pharmacy Networks, Client Services, Implementation, Compliance, and other departments.

• Offer clinical education and support to internal team members.

• Engage in client discussions, program evaluations, and internal strategy meetings.

• Promote standardized processes, resources, and training materials.

• Ensure compliance with federal and state regulations, contractual obligations, clinical standards, and internal policies.

• Maintain records of clinical decisions, program criteria, and modifications.

• Identify risks, quality issues, and process shortcomings and escalate as necessary.

• Stay informed on pharmaceutical trends, emerging therapies, drug pricing, and industry practices.

• Suggest process enhancements that support program quality and scalable growth.

⛳️ Requirements

• Doctor of Pharmacy (Pharm.D.) degree from an accredited college of pharmacy.

• Active pharmacist license in good standing within the state of residence, with the capability to obtain additional licensure as needed for the position.

• Comprehensive clinical knowledge of pharmacotherapy, medication utilization, formulary management, and evidence-based prescribing.

• Proven analytical, problem-solving, and critical-thinking abilities.

• Capability to interpret clinical data and translate findings into actionable recommendations.

• Excellent written and verbal communication skills.

• Proficiency in collaborating effectively across departments and with stakeholders at various organizational levels.

• Strong organizational capabilities and the ability to juggle multiple priorities in a dynamic, fast-paced setting.

• Experience in a pharmacy, PBM, healthcare, or clinical environment preferred.

• Familiarity with formulary management or pharmacy benefit operations preferred.

• Experience in supporting clinical programs or healthcare initiatives preferred.

• Proficiency with spreadsheets, reporting tools, workflow systems, or project-management tools preferred.

• Familiarity with pharmacy terminology and clinical program concepts preferred.

• Experience in documenting processes and developing standard operating procedures preferred.

• SQL experience is a plus.

🏝️ Benefits

• A diverse range of health insurance options, including medical, dental, and vision coverage.

• Competitive salary and bonus structure.

• A robust 401k plan with company matching.

• ESOP shares allocated annually through a qualified retirement plan.

• Employee Assistance Program.

• Wellness program that includes financial incentives, chiropractic and massage services, and fitness stipends.

• Dream Manager Program.

• A supportive, family-oriented culture.

• Opportunities for charitable contributions and volunteer time.