UNITE HERE HEALTH

  • Temporary Clinical Pharmacist

    Job Locations US-IL-Aurora
    Posted Date 1 month ago(9/18/2018 10:07 AM)
    ID
    2018-1481
    # of Openings
    1
    Category
    Other
    Company
    UNITE HERE HEALTH
  • Overview

    betterworkplaceuhh

     

     

    Looking for a way to influence the health and healthcare of many?

     

    If so, we’d love to hear from you! Our mission-driven organization is focused on theTriple Aim - Better Health, Better Healthcare and Lower Costs to individuals and their families who participate in our health plans.

     

    UNITE HERE HEALTH serves 100,000+ workers and 220,000 covered lives in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!

     

     

    Key Attributes:

     

    • Integrity – Must be trustworthy and principled when faced with complex situations
    • Ability to build positive work relationships – Mutual trust and respect will be essential to the collaborative relationships required
    • Communication – Ability to generate concise, compelling, objective and data-driven reports
    • Teamwork – Working well with others is required in the Fund’s collaborative environment
    • Diversity – Must be capable of working in a culturally diverse environment
    • Continuous Learning – Must be open to learning and skill development.  As the Fund’s needs evolve, must be proactive about developing new areas of expertise
    • Lives our values – Must be a role model for the Fund’s BETTER Culture and Mission (Better, Engage, Teamwork, Trust, Empower, Respect)

     

    Responsibilities

    • Reviews formulary exception and prior authorization requests and makes determinations for drug products according to member benefits, established treatment protocols and clinical criteria
    • Researches drug information to maintain drug knowledge and disease state understanding for application to formulary exception and prior authorization reviews
    • Supports the determination, appeal and grievance process for prescription and medical drug benefits
    • Makes coverage determinations within the defined turnaround times and meets regulatory requirements
    • Collaborates with the pharmacy director to research and synthesize detailed clinical data related to pharmaceuticals to identify opportunities for improving quality or overall cost
    • Supports medical cost management, utilization management and medication management initiatives, projects and related activities
    • Supports Hospitality Rx’s efforts around researching, developing and revising pharmacy and medical coverage guidelines
    • Assists in the development of clinical criteria for the Pharmacy and Therapeutics Committee; participates in support of the Pharmacy and Therapeutics Committee
    • Assists in Hospitality Rx’s efforts to develop and design clinical edits to adjudicate claims and enhance drug utilization
    • Performs comprehensive and targeted medication reviews to identify, resolve, and prevent medication-related problems for targeted members
    • Provides clinical guidance and support
    • Utilizes prescription and medical claims data to generate clinical recommendations
    • Serves as pharmacy subject matter expert (SME) on projects; supports internal business partners such as care/case managers, health promoters and member services
    • Provides internal professional staff and external member and provider education related to pharmaceuticals, disease states and program interventions.
    • Collaborates with pharmacy director and manager to help with workflows and operational efficiencies
    • Reviews and resolves complaints made by member and providers regarding prior authorization, formulary or pharmacy services
    • Performs other duties as assigned within the scope of responsibilities and requirements of the job
    • Performs Essential Job Functions and Duties with or without reasonable accommodation

    Qualifications

    Years of Experience and Knowledge

    • 5 ~ 7 years of direct experience minimum
    • 0 ~ 2 years of experience in a managed care environment or clinical management role preferred
    • Working knowledge of Pharmacy Benefit Manager (PBM) industry, formulary management, pharmacy claims, and managed care principles and practices preferred.

    Education, Licenses, and Certifications

    • Bachelor's degree in Pharmacy with optional post-graduate training or related field or equivalent work experience required
    • Doctor of Pharmacy (PharmD) preferred
    • Required: Valid Illinois Pharmacist License

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