RESPONSIBILITIES

Responsible for the administration of pharmaceutical services to CFHP members for all lines of business. Implements decisions set forth by the CFHP Pharmacy & Therapeutics Committee. Evaluates medication utilization and prior authorization requests for medications available via the pharmacy benefit and the medical benefit including specialty ambulatory injectable and/or infusion medications as related to member benefits, medical necessity, site of service, and evidence based clinical guidelines. The Population Health Management Pharmacist functions in a clinical role supporting the development and integration of clinical care models for chronic conditions in collaboration with departments across the health plan. Applies critical thinking, clinical knowledge, evidence-based policies, procedures and clinical guidelines to collaborate with health plan departments to promote quality improvement and care coordination. Adheres to all Federal, State, local laws and regulations applicable to health plan pharmacy services and plan design. The primary role of the Population Health Management Pharmacist is to provide leadership and guidance for the plan’s various population health related goals such as Medicare Part D Star Ratings and medication related Healthcare Effectiveness Data and Information Set (HEDIS) measures to achieve continuous improvement and overall high quality metric scores.

EDUCATION/EXPERIENCE

Doctorate in Pharmacy (Pharm.D) required. Post-Doctorate residency preferred. A minimum of five (5) years of experience in a clinical pharmacy position is required. Strong communication and computer skills are required. Six Sigma, Lean (or other quality program) background. Experience in pharmacy benefits management, Medicaid, Commercial and Medicare Part B & D preferred.

LICENSURE/CERTIFICATION

Must be licensed by the Texas State Board of Pharmacy. Must be registered with the Texas State Board of Pharmacy as a preceptor. Board Certified Pharmacotherapy Specialist (BCPS) preferred.