Senior Clinical Pharmacy Strategist

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

• →Track, analyze, and interpret quality metrics to identify gaps in care, improve outcomes and ascertain opportunities for improvement.
• →Partner cross-functionally with Care Management, Utilization Management, Provider Network, and Medical Directors to design and deploy integrated quality performance programs to enhance member outcomes and provider engagement.
• →Lead the creation and execution of clinical program strategies that align with organizational goals and advance STARS and HEDIS performance metrics through targeted pharmacy initiatives.
• →Design dashboards and reporting tools to monitor quality metrics and pharmacy impact on STARS.
• →Develop strategic plans with defined goals, objectives, and success metrics; present program proposals and performance outcomes to senior leadership and quality committees for endorsement and support
• →Ensure programs comply with regulatory requirements and quality standards.
• →Monitor and evaluate program performance, making data-driven adjustments as needed.
• →Facilitate workgroups and committees to gather input and drive program development.
• →Maintain a detailed understanding of all shared data elements (drug data including GPI, NDC, HCPC, and ICD-10 coding) and the systems necessary to support actionable interventions.
• →Conduct outcome analyses to evaluate quality programs, initiatives and interventions utilizing multiple data sources to determine the effectiveness of activities and make recommendations to improve outcomes for CMS Stars, NCQA, QIM (HEDIS, CAHPS).
• →Provide structured project management for clinical initiatives, ensuring timely and within-scope completion.
• →Develop and manage within project timelines, budgets, and resources.
• →Coordinate cross-functional teams to develop and deploy annual improvement plans with performance metrics, monitor risk, deploy mitigation strategies and elevate to joint operating committees as needed.
• →Lead quality improvement initiatives to enhance patient care and safety.

• →Work with Clinical Pharmacy leadership to improve processes, systems, reporting, and services provided by the department.
• →Support Clinical Pharmacy leadership by delivering actionable data analytics that inform enterprise cost-of-care strategies and monitor clinical team performance metrics, as assigned.
• →Assists Leadership in the planning, development, and implementation of the clinical and operational processes for MTM Services within Medicare Part D products
• →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.

Adaptability

Building Customer Loyalty

Building Strategic Work Relationships

Building Trust

Continuous Improvement

Contributing to Team Success

Planning and Organizing

Work Standards

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.