ACA Clinical Pharmacist PCHP

Responsible for managing pharmacy operations and clinical activities for Parkland Community Health Plan (PCHP) including the contracted pharmacy benefit manager, ensuring the development, implementation, and management of clinical pharmacy initiatives for PCHP, including Marketplace/ACA members to ensure optimal drug treatment outcomes and minimize costs.

Responsibilities

Manage pharmacy operations and clinical activities for Parkland Community Health Plan (PCHP) including the contracted pharmacy benefit manager; Develop, implement, and manage clinical pharmacy initiatives for PCHP, including Marketplace/ACA members, to ensure optimal drug treatment outcomes and minimize costs; Provide vendor oversight and manage the pharmacy benefit manager contract for ACA business; Oversee the development and maintenance of the Drug Formulary and Prior Authorization list; Complete prior authorization review of high-cost medications based on clinical criteria; Perform comprehensive medication regimen reviews for members; Develop clinical and administrative reports, dashboards, and pharmacoeconomic data analyses; Lead PCHP's pharmacy fraud, waste, and abuse audits and pharmacy quality management activities; Coordinate pharmacy regulatory readiness and compliance, including external surveys and regulatory reporting; Conduct routine compliance audits and implement remediation plans; Support the Appeals department with clinical support; Manage the approved pharmacy budget and promote operational efficiency; Support and educate operational teams on pharmacy matters for the ACA line of business; Cross-cover Medicaid pharmacy activities as needed

Requirements

Doctor of Pharmacy degree (Pharm D) required; Six (6) years of experience as a practicing pharmacist in a healthcare, health plan or managed care organization required; Current and unrestricted license as a pharmacist in the State of Texas; Excellent verbal and written communication skills; Demonstrated ability to coach and influence for results; Strong interpersonal and conflict resolution skills; Strategic thinking and long-range planning skills; Ability to work in challenging situations involving competing interests and high-level interdisciplinary groups; Excellent time management and organizational skills; Advanced analytical and problem-solving skills; Knowledge of programs, regulations, and standards for ACA/Marketplace plans, CMS, Texas Medicaid (STAR, STAR Kids/CHIP), NCQA, Uniform Managed Care Contract, Uniform Managed Care Manual, TDI, State Board of Pharmacy, DEA, FDA, and Vendor Drug Programs (VDP); Sound business acumen; Proficient Microsoft Office and computer skills

Nice to have

Experience working within a health plan or managed care organization; Completion of a Pharm D post graduate residency program; Three (3) years of experience with utilization management in a health care delivery setting; Experience with commercial or Marketplace products; Project management or Six Sigma certification