Medical Mutual · 7 hours ago
Clinical Pharmacist II
United States
Full-time
Remote
Mid Level
3+ years expMedical Mutual is the oldest and one of the largest health insurance companies based in Ohio, providing high-quality health coverage to over 1.2 million members. The Clinical Pharmacist II role involves developing and implementing clinical programs, supporting formulary and policy development, and engaging with health systems to improve medication quality and cost-effectiveness.
Health CareHealth InsuranceInsuranceLife Insurance
Responsibilities
Based on assigned pharmacist specialty area, may include any of the following (% of time per function will vary):
Develops policies and strategies to engage members and/or providers and help drive improvements in pharmaceutical care and pharmacy quality measures to decrease drug spend
Addresses Medicare STAR drugs (STATIN, RASA, and non-insulin diabetes) adherence gaps
Reviews drug/medical literature, clinical practice guidelines, quality measures, and available national guidelines to support formulary, drug policy or drug therapy interventions and creation of new initiatives
Interacts with PBM/vendor oversight activities including regular or ad-hoc audits of clinical programs
Develops and implements programs to communicate and educate internal staff, external brokers, strategic health systems, pharmacy chains and provider groups
Performs Consumer Assessment of Healthcare Providers and Systems (CAHPS)-focused interventions to improve drug plan perception
Promotes the value-add of the Company’s pharmacy services with internal and external stakeholders. Develops relationships and partnerships to support health systems engagement or sales efforts
Assists Sales in selling and renewing pharmacy services, or retaining business, by attending meetings, promoting pharmacy benefits and services, developing responses to Request for Proposal (RFP), recommending solutions to brokers and their clients, etc
Collaborates with pharmacy departments within the Company’s strategic health systems, pharmacy chains and provider groups to implement programs which better engage members to improve overall medication quality performance and cost of care for attributed populations by facilitating regular interactions to build and support the clinical relationship
Assists in closing Medicare STARS-related gaps by completing Comprehensive Medication Reviews (CMRs), Medication Reconciliation Post-Discharge (MRPs), and In-Home Assessments (IHAs)
Partners with internal departments including Medicare STARS, Clinical Quality Health Services, Provider Network Management, HEDIS, and Customer Care to develop and implement programs and clinical initiatives to support achievement of strategic goals
May orient, train, and assist new hires, residents, and junior level Pharmacists. Maintains and shares clinical knowledge and knowledge of prescription benefit trends
Performs other duties as assigned
Qualification
Required
Doctor of Pharmacy (Pharm.D.) preferred. Bachelor of Pharmacy with relevant experience may be considered
3 years of experience as a Clinical Pharmacist or equivalent experience in a managed care pharmacy setting
Registered Pharmacist with current unrestricted license from the appropriate State Board of Pharmacy
May be required to obtain Ohio State Board of Pharmacy license within 6 months of hire
Understanding of managed care pharmacy, including formulary design/management, drug utilization management, and/or quality assurance programs
Knowledge of medical/pharmacy terminology/coding and specialty drug management
Good clinical acumen and strategic analysis skills
Microsoft Office skills specifically Excel and Pharmacy Benefit Management (PBM) systems; basic proficiency with Visio and/or Access
Ability to present clinical information to various internal and external audiences
Preferred
Medicare/Medicaid experience preferred
Benefits
Employee bonus program.
401(k) with company match up to 4% and an additional company contribution.
Health Savings Account with a company matching contribution.
Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.
Career development programs and classes.
Mentoring and coaching to help you advance in your career.
Tuition reimbursement up to $5,250 per year, the IRS maximum.
Company
Medical Mutual
Medical Mutual Provides and administers health benefits for citizens in Ohio.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Annette Terrien Hill
RNI Chief Operating Officer
Christopher Donovan
Executive Vice President, Chief Data and Information Officer
Recent News
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