Clinical Pharmacist Consultant – Senior

🕒 July 2

🥔 Idaho, Oregon, +2 more states – Remote

🥔 Idaho – Remote 🌲 Oregon – Remote ⛷️ Utah – Remote ☕ Washington – Remote

💵 $114k - $186k / year

⏰ Full Time

🟠 Senior

💊 Pharmacist

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Cambia Health Solutions

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare • Healthcare Insurance • Non-profit

Cambia Health Solutions is a nonprofit, mission-driven healthcare company based in Portland, Oregon, that operates consumer-focused health care and health insurance businesses and invests in health innovation. It serves as the parent organization for the Regence family of health plans and runs initiatives and subsidiaries focused on improving care delivery, providing insurance products, and developing digital health tools and services.

📋 Description

• Provide clinical decision-making based on best practices in applying evidence-based medicine process in determining medications that have best value for efficacy and safety. • Provide coverage recommendations for medications subject to prior authorization, appeals, retrospective claim reviews, and audits based on applicable medication coverage policies, member benefit contracts, and provider contracts. • Complete peer-to-peer conversations with external healthcare professionals. • Develop position papers, medication coverage policies, formulary monographs and class reviews, and formulary coverage recommendations based on critical appraisal of the scientific literature and input from practicing physicians to ensure optimal clinical outcomes at most cost-effective level. • Present and/or communicate clinical positions on medication analysis in clear, concise manner.

🎯 Requirements

• Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD) or related field • Minimum 3-5 years of experience in clinical acute care/hospital setting or equivalent combination of education and experience • Pharmacy license. • Successful completion of a pharmacy residency or advanced degree in health-related field preferred. • Must be an active and unrestricted licensed pharmacist in state of practice • Strong clinical pharmacy background with ability to demonstrate clinical therapy skills and knowledge in a clinical care setting. • Excellent verbal and written communication skills; strong business analytical skills and abilities; strong project management and coordination ability. • Ability to work independently, to prioritize work, meet deadlines and achieve operational goals • Demonstrated success in managing professional relationships in a managed care system, medical group, hospital, or related organizations. • Ability to collaborate as part of cross functional teams, to improve clinical programs, enhance processes and share clinical information. • Knowledge of pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA. • Strong knowledge of health care economics and financing; health care/pharmaceutical industry dynamics; and pharmacy/provider service reimbursement of medications. • Knowledge of Health Plan and benefit design structures and application; Medicare/CMS regulations and applicability in administering the Medicare Product; health care coding and payment systems (such as ICD-9, CPT, HCPCS, NDC). • Strong knowledge of compliance related activities, legislative and regulatory activities, health insurance operations, and legal issues. • Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

🏖️ Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits. • Annual employer contribution to a health savings account. • Generous paid time off varying by role and tenure in addition to 10 company-paid holidays. • Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period). • Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave). • Award-winning wellness programs that reward you for participation. • Employee Assistance Fund for those in need. • Commute and parking benefits.