Clinical Pharmacist Specialist II

Join PacificSource and help our members access quality, affordable care!

• →Provide subject matter expertise in a specialized pharmacy process (such as formulary management, quality or population health initiatives, or Pharmacy and Therapeutics Committee reviews) and effectively collaborate with internal partners to maximize deliverables.
• →Work with Pharmacy Leadership to strategically improve processes, systems, reporting, and services provided by the department.
• →Lead or support clinical meetings with internal and external stakeholders as requested.
• →Lead or assist in projects as assigned.
• →Assist with resident training.
• →Assist training pharmacy staff in specialized workflows as assigned.
• →Collaborate with pharmacy leadership to create and maintain training documents
• →Stay up to date on State and Federal regulations as they relate to health insurance coverage and the practice of pharmacy.
• →Stay up to date on quality measures pertinent to Pharmacy Services.
• →Provide effective communication for members, providers, and internal staff through various platforms such as clinical calls, coverage determination letters, and email.

• →Act as backup for other team members and departmental functions.
• →Provide accurate and timely drug coverage determinations for members of PacificSource Health Plans based on posted criteria, current standards of medical practice, and member-specific condition.
• →Assist Medical Directors in reviewing appeals for denied coverage determinations.
• →Represent Pharmacy Services Department, both internally and externally, as requested
• →Meet department and company performance and attendance expectations.
• →Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• →Perform other duties as assigned.

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.

• We are one team working toward a common goal.

• We are each responsible for customer service.

• We practice open communication at all levels of the company to foster individual, team and company growth.

• We actively participate in efforts to improve our many communities-internally and externally.

• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.

• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.