Health Plan Clinical Pharmacist I - Kelsey Seybold Clinic - Pearland Admin Office - Remote

Pharmacy Quality Initiatives Manager

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing Together.

Primary Responsibilities:

• Under the supervision of the Part D Pharmacy Manager - Health Plan Services, this position is primarily responsible for performing and/or supervising pharmacist activities related to all Pharmacy Quality Initiatives (i.e. RxQI, MTMP, Adherence, Hospital Discharge Prgm, Fraud Waste and Abuse monitoring, Part D coverage determination and appeals processing) for Kelsey-Seybold Clinic and/or KelseyCare Advantage
• Oversee program staff as well as monitor and report ongoing progress of pharmacy quality initiatives
• Perform operational maintenance and/or implementation of new clinical services as well as any additional duties deemed necessary for the Pharmacy Services Department

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Pharm D. degree
• Current and Active Pharmacy License
• TSBP Registered Pharmacist
• 3+ years operational pharmacy benefit experience, clinical and/or retail pharmacy experience
• Ability to communicate verbally and in writing with Health Plan Pharmacy Services Department personnel to delegate duties, inform about policies and assist in training
• Ability to communicate with physicians and other healthcare personnel to discuss specific medication recommendations, therapies for cost-effective care, general drug information, and educate about health plan prescription drug benefits
• Ability to communicate verbally and in writing with members/patients/vendors to handle complaints and problems, assist with questions, and recommend products/recommendations
• Ability to write reports (i.e., weekly/monthly), maintain audit logs, perform oversight and communicate concerns
• Proven good Alpha/Numeric data entry skills with minimal errors
• Demonstrated solid multitasking, problem solving & analytical skills
• Proficient with computer applications

Preferred Qualifications:

• Completion of a Managed Care Pharmacy Residency Program or Pharmacy Practice Residency Program (PGY1)
• ASHP Immunization Certification
• BLS CPR Certification
• 3+ years of HMO 3rd party managed care experience
• 3+ years of Medicare Part D experience
• Experience with prior authorization, coverage determination and appeals processing
• Experience with vendor relations
• Staff management experience
• Proven knowledge of Medicare regulations with emphasis on Part D formulary, coverage determination and appeals processing
• Proven knowledge of the Pharmacy Benefit Management (PBM) industry
• Proven knowledge of Medicare 5-star ratings and HEDIS measures
• Customer service experience
• Auditing experience

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.