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Lead Clinical Pharmacy Specialist

Job Description

In support of the EmblemHealth Pharmacy Quality program focused on initiatives to meet corporate STAR goals.  As part of the Comprehensive Medication Management Program, conduct interviews, develop, facilitate and communicate a plan of care to remove barriers for members who have been identified as having difficulty with medication adherence. Continuously evaluate plan of care and revise as needed. As part of the Medication Therapy Management Program, conduct and document according to CMS standards annual comprehensive medication reviews. 

 

Responsibilities

As part of the Comprehensive Medication Management Program: 

  • Conduct patient medication history reviews face to face and telephonically. Carry a case load of 150 per month.
  • Identify barriers to care and work collaboratively with the patient to resolve barriers. 
  • Recommend changes in drug therapy and lifestyle based on information obtained through patient interviews, interactions, objective monitoring parameters, review of drug profiles and the patient medical record.
  • Identify, resolve, and prevent potential and actual medication-related problems including: untreated indications, improper drug selection, subtherapeutic dosage, overdose, failure to receive medication, adverse drug reactions, drug interactions, and medication without indication.
  • Provide patient monitoring for evaluating and optimizing patient outcomes, drug utilization and patient compliance, detecting and/or minimizing ADR's, eliminating unnecessary drug use and duplication.
  • Provide patient education related to the individual's disease state, including predictable actions, side effects, reasons for proper compliance, and any special instruction.
  • Document interactions and care plans within the applicable software.

As part of the Medication Therapy Management Program:

  • Deliver and accurately document in a timely manner MTM services to assess appropriateness of all medications, optimize medication therapy, improve clinical outcomes and serve as a drug information resource to patients and interdisciplinary teams.  Complete an average of 200 CMR’s per month.
  • Coordinate medication reconciliation across the continuum of care by providing comprehensive reviews, addressing adherence concerns, assisting with patient education and monitoring clinical outcomes to help prevent unnecessary readmissions, lapses in care and adverse drug reactions
  • Assist with managing medication costs through cost-effective interventions which may include, but are not limited to formulary and therapeutic interchanges, and assessing unnecessary and/or duplicate medication therapies
  • Efficiently assess prescribed medication therapy for unnecessary medications, need for additional medications, ineffective medications, inappropriate doses, adverse drug reactions, and adherence concerns
  • Determine appropriate interventions to resolve medication ther•  Collaborate with prescribers, interdisciplinary care teams, patients and/or caregivers to identify and develop patient-specific disease state therapy goals
  • Communicate professionally and discuss/document clinical recommendations/interventions to prescribers and interdisciplinary care teams
  • Ensure maintenance and compliance with clinical standards of the CMMP and MTM services provided, and remain up-to-date with clinical knowledge
  • Maintain comprehensive knowledge of policies and procedures, and perform in accordance with applicable regulatory and accreditation requirements or standards as they relate to assigned responsibilities and functions
  • Aid in the evaluation and maintenance of formulary set-up based on clinical requirements, compliance with regulatory bodies, and P&T rules.
  • Other projects/ duties as assigned.apy problems, achieve goals of therapy and prevent new medication therapy problems


Job Requirements

Qualifications

  • Bachelors’ Degree
  • PharmD from an accredited college of pharmacy
  • Current, unrestricted Pharmacist License or Registered Nurse License in accordance with a respective state licensing board of residency
  • MTM training program completion by APhA or PowerPak C.E. preferred.
  • PGY-1 residency program in community pharmacy/ambulatory care/geriatric pharmacy/managed care pharmacy preferred.
  • Clinical Pharmacy Board Certified via BPS or NBMTM preferred.
  • Fluent in an additional one or more languages preferred.
  • 10+ years of relevant, professional work experience. (R)
  • 3 – 5 years specific, position-related experience (R)
  • Experience with administering CMS Comprehensive Medication Reviews (R)
  • Managed care experience (P)
  • Strong communication skills, including motivational interviewing (R)
  • Strong clinical therapeutic skills; knowledge of appropriate medication dosing in geriatric and adult populations. (R)
  • Excellent critical thinking and problem-solving skills (R)
  • Computer/technology competent (R)
  • Industry level understanding of STAR measures and methods for improving service delivery to maximize ratings (R)
  • Ability to work independently in a collaborative environment, be self-directed and possess excellent organizational skills (R)
  • Ability to work effectively with patients, their families, professionals, and other personnel from a wide range of cultural, social and economic backgrounds (R)
  • Ability to communicate professionally with all necessary parties associated with the patient’s care plan (R)

Job Snapshot

Location US-NY-New York
Employment Type Full-Time
Pay Type Year
Pay Rate N/A
Store Type Health Care
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Company Overview

EmblemHealth

EmblemHealth is a local, neighborhood health plan that has served the New York City area and surrounding communities for more than 75 years. That’s the kind of experience that makes us unique. We’re proud to be one of the nation’s largest not-for-profit health plans, serving 3.1 million people who live and work across the New York tri-state area. Learn More

Contact Information

US-NY-New York
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Snapshot
EmblemHealth
Company:
US-NY-New York
Location:
Full-Time
Employment Type:
Year
Pay Type:
N/A
Pay Rate:
Health Care
Store Type:

Job Description

In support of the EmblemHealth Pharmacy Quality program focused on initiatives to meet corporate STAR goals.  As part of the Comprehensive Medication Management Program, conduct interviews, develop, facilitate and communicate a plan of care to remove barriers for members who have been identified as having difficulty with medication adherence. Continuously evaluate plan of care and revise as needed. As part of the Medication Therapy Management Program, conduct and document according to CMS standards annual comprehensive medication reviews. 

 

Responsibilities

As part of the Comprehensive Medication Management Program: 

  • Conduct patient medication history reviews face to face and telephonically. Carry a case load of 150 per month.
  • Identify barriers to care and work collaboratively with the patient to resolve barriers. 
  • Recommend changes in drug therapy and lifestyle based on information obtained through patient interviews, interactions, objective monitoring parameters, review of drug profiles and the patient medical record.
  • Identify, resolve, and prevent potential and actual medication-related problems including: untreated indications, improper drug selection, subtherapeutic dosage, overdose, failure to receive medication, adverse drug reactions, drug interactions, and medication without indication.
  • Provide patient monitoring for evaluating and optimizing patient outcomes, drug utilization and patient compliance, detecting and/or minimizing ADR's, eliminating unnecessary drug use and duplication.
  • Provide patient education related to the individual's disease state, including predictable actions, side effects, reasons for proper compliance, and any special instruction.
  • Document interactions and care plans within the applicable software.

As part of the Medication Therapy Management Program:

  • Deliver and accurately document in a timely manner MTM services to assess appropriateness of all medications, optimize medication therapy, improve clinical outcomes and serve as a drug information resource to patients and interdisciplinary teams.  Complete an average of 200 CMR’s per month.
  • Coordinate medication reconciliation across the continuum of care by providing comprehensive reviews, addressing adherence concerns, assisting with patient education and monitoring clinical outcomes to help prevent unnecessary readmissions, lapses in care and adverse drug reactions
  • Assist with managing medication costs through cost-effective interventions which may include, but are not limited to formulary and therapeutic interchanges, and assessing unnecessary and/or duplicate medication therapies
  • Efficiently assess prescribed medication therapy for unnecessary medications, need for additional medications, ineffective medications, inappropriate doses, adverse drug reactions, and adherence concerns
  • Determine appropriate interventions to resolve medication ther•  Collaborate with prescribers, interdisciplinary care teams, patients and/or caregivers to identify and develop patient-specific disease state therapy goals
  • Communicate professionally and discuss/document clinical recommendations/interventions to prescribers and interdisciplinary care teams
  • Ensure maintenance and compliance with clinical standards of the CMMP and MTM services provided, and remain up-to-date with clinical knowledge
  • Maintain comprehensive knowledge of policies and procedures, and perform in accordance with applicable regulatory and accreditation requirements or standards as they relate to assigned responsibilities and functions
  • Aid in the evaluation and maintenance of formulary set-up based on clinical requirements, compliance with regulatory bodies, and P&T rules.
  • Other projects/ duties as assigned.apy problems, achieve goals of therapy and prevent new medication therapy problems


Job Requirements

Qualifications

  • Bachelors’ Degree
  • PharmD from an accredited college of pharmacy
  • Current, unrestricted Pharmacist License or Registered Nurse License in accordance with a respective state licensing board of residency
  • MTM training program completion by APhA or PowerPak C.E. preferred.
  • PGY-1 residency program in community pharmacy/ambulatory care/geriatric pharmacy/managed care pharmacy preferred.
  • Clinical Pharmacy Board Certified via BPS or NBMTM preferred.
  • Fluent in an additional one or more languages preferred.
  • 10+ years of relevant, professional work experience. (R)
  • 3 – 5 years specific, position-related experience (R)
  • Experience with administering CMS Comprehensive Medication Reviews (R)
  • Managed care experience (P)
  • Strong communication skills, including motivational interviewing (R)
  • Strong clinical therapeutic skills; knowledge of appropriate medication dosing in geriatric and adult populations. (R)
  • Excellent critical thinking and problem-solving skills (R)
  • Computer/technology competent (R)
  • Industry level understanding of STAR measures and methods for improving service delivery to maximize ratings (R)
  • Ability to work independently in a collaborative environment, be self-directed and possess excellent organizational skills (R)
  • Ability to work effectively with patients, their families, professionals, and other personnel from a wide range of cultural, social and economic backgrounds (R)
  • Ability to communicate professionally with all necessary parties associated with the patient’s care plan (R)

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