Pharmacist Clinical Senior (SMI/HIV Membership)
Elevance Health

Job Info

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Pharmacist Clinical Senior

Location: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations in Florida.

The Pharmacist Clinical Senior will be responsible for developing and implementing pharmacy programs for the Florida Health Plan. The Pharmacist Clinical Senior will be the primary contact for the FL Medicaid Health Plan's SMI (Serious Medical Issues) and HIV pharmacy program managing stakeholder communications as well as ensuring the proper reaction to and resolution of issues concerning the pharmacy benefit program. The Pharmacist Clinical Senior will act as a support resource for the sales team regarding efforts to improve the performance of the pharmacy benefit for existing accounts. The FL Health Plan is looking for a dedicated pharmacist to support the SMI/HIV population.

How you will make an impact:

• Act as a liaison with CM/CC department on medication concerns, provider networks, and pharmacies.
• Resolve AHCA member complaints related to pharmacy.
• Identify trends and cost-effective alternatives.
• Identify and address medication adherence, polypharmacy, medication contraindications, medications indicated that are not prescribed (e.g., statins) or other concerns in collaboration with pharmacies, providers, and CM department.
• Deliver Med review care management summaries to providers.
• Provide targeted, monthly communications to physicians. Communications include personalized, actionable information about their patients to promote optimal coordination of care and information on appropriate use, compliance, and safety of medications. Targeted conditions: Schizophrenia, Bipolar, Diabetes, Asthma, Depression, Cholesterol among others.
• Ensure community pharmacy participation and support.
• Oversee Drug Utilization Reviews (DUR).
• Administer HEDIS Measures and State Dashboard Measures related to pharmacy.
  • Drive measures
  • Develop reports for CM (e.g., Members missing antipsychotic medication refill; HUD)
  • Participation in multi-disciplinary rounds and provider meetings as needed
  • OUD/MAT - Includes Controlled Substance Utilization Management Program (CSUM) - uses several Retrospective DUR reviews designed specifically to decrease controlled substance overutilization, including opioids
  • MMPs progress reporting and communication with CM teams
• Oversee Pharmacy Restriction Program.
• Assist the FL Pharmacy Director in clinical related State PDL duties.
• Monitor utilization and trends among HIV experienced (Red Ribbon) and non-experienced providers.
• Support to our HIV experienced PCPs who increasingly treat an aging population with behavioral and co-morbid conditions resulting in complex pharmaceutical portraits.
• Act as a liaison to other HIV pharmacists from key provider groups and specialty pharmacies serving persons living with HIV.
• Lead initiatives to enhance HIV treatment adherence to reduce viral load, a key performance metric for the specialty health plan.
• Serve as in-house SME and resource for providers that may be prescribing HIV treatment regimens that are outside of the recommended guidelines.
• Collaborate with Quality, Case Management, Provider Relations, Finance, and other departments with a shared goal of improving outcomes and reducing costs.

Minimum Requirements:

• Requires BA/BS in Pharmacy and a minimum of 4 years of experience as a pharmacist in a clinical setting; or any combination of education and experience, which would provide an equivalent background.
• Requires a registered pharmacist.
• Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh).

Preferred Skills, Capabilities, and Experiences:

• PharmD preferred.
• Experience with physical health and psychiatric conditions/medications for children and adults preferred.
• Prior knowledge and experience with HIV and SMI as it relates to specialty pharmaceuticals.
• Understanding of LAIs and alternative treatment methods preferred.
• Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US, unless they are command-sanctioned activities.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

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