Clinical Pharmacist Consultant

Remote in WA, ID, OR, UT

Primary Job Purpose

Provides professional and clinical expertise for Pharmacy Services’ clients in making clinical decisions based on best practices by applying evidence-based medicine evaluations to determine the best quality medication choices that represent the best value in efficacy, safety and affordability. This includes providing coverage recommendations for medications subject to prior authorization, appeals, retrospective claim reviews, and audits based on applicable medication coverage policies, member benefit contracts, and provider contracts.

This role may also assist in planning, developing, and implementing clinical strategies with respect to formulary management, drug utilization management, medication therapy management programs, quality initiatives, gaps in care, peer to peer conversations and drug information and education. Advanced responsibilities may include analyzing health care cost information, development of position papers, medication coverage policies, formulary monographs and class reviews, cross-functional projects, and initiatives related to the provision of pharmacy benefits that impact safety, quality and affordability.

General Functions and Outcomes

• Responsible for delivering high quality clinical services for Pharmacy Services’ clients for Medication Benefit Management.

• May be responsible for conducting peer clinical reviews. (The medical director has the responsibility to determine that the peer clinical reviewers are qualified to render a clinical opinion for items under review.)

• May be responsible for peer to peer conversations.

• Works independently within framework and guidelines to evaluate intangibles associated with cost-containment and quality improvement of prescription drug charges.

• Provide coverage recommendations for medications subject to prior authorization, appeals, retrospective claim reviews, and audits based on applicable medication coverage policies, member benefit contracts, and provider contracts.

• Provides clinical decision-making based on best practice in applying evidence-based medicine process in determining medications that have best value for efficacy and safety.

• Develops and provides educational materials and correspondences to members to inform them about medication coverage choices, comparative effectiveness, and coverage determinations.

• Knowledge of pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA.

Minimum Requirements

• Clinical pharmacy background with ability to demonstrate clinical therapy skills and knowledge in a clinical care setting.

• Demonstrated success in managing professional relationships in a managed care system, medical group, hospital, or related organizations.

• Excellent verbal and written communication skills; strong business analytical skills and abilities; strong project management and coordination ability. 

Normally to be proficient in the competencies listed above:

Clinical Pharmacist Consultant would have a Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD) or related field and 3-5 years of experience in clinical acute care/hospital setting or equivalent combination of education and experience.

Required Licenses, Certifications, Registration, Etc.

Pharmacy license. Successful completion of a pharmacy residency or advanced degree in health-related field preferred. Must be an active and unrestricted licensed pharmacist in state of practice.

#LI-Remote

The expected hiring range for a Clinical Pharmacist Consultant is $119,900 - $162,200 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 15 %. The current full salary range for this role is $112,000 - $184,000 .

Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:

• medical, dental, and vision coverage for employees and their eligible family members

• annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)

• paid time off varying by role and tenure in addition to 10 company holidays

• up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)

• up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)

• one-time furniture and equipment allowance for employees working from home

• up to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com . Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy . As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.