Job Description

We’re looking for a Clinical Programs Manager Pharmacist, someone who’s ready to grow with our company. In this position you will be a key driver of the pharmacy based clinical programs, disease management initiatives, provider education, and utilization management review. This is an individual contributor role without direct reports but requires indirectly leading initiatives and other staff. This position works closely with leadership and other key personnel to execute operational goals, ensure quality control, and identify process improvement opportunities. The role serves as are source and mentor to members, network providers, employees, and external collaborators.

Think you’ve got what it takes?

Job Duties & Responsibilities

• Independent utilization review of clinician administered drugs, and pharmacy appeals and collaboration with medical director team supporting benefit administration, policy development, and outcome tracking/reporting.
• Manage and enhance pharmacy-based clinical and quality improvement initiatives for the health plan impacting member benefits and health outcomes
• Ensure clinical projects and tasks are completed in a timely manner, and operational goals are met. Uses data to measure quantifiable outcomes and interventions, presenting progress to leadership team. Provides support staff with guidance to ensure achievement of goals.
• Manages and leads various clinical programs. Examples include but are not limited to: The Office of Inspector General (OIG) lock-in program, psychotropic medication utilization review (PMUR), retrospective drug utilization review (RDUR), prospective drug utilization review (PDUR), and others.
• Coordinates and participates in performance and/or quality improvement activities. Identify process improvement opportunities. With support from the leadership team, present and execute improvement plans.
• Participates in and leads multi-disciplinary work groups involving clinical operations, NCQA accreditation compliance, and pharmacy benefit manager (PBM) oversight. This includes internal and external stakeholders.
• Creates pharmacy guides and training content for internal and external stakeholders.
• Completes clinical and compliance tasks.
• Participate in the education of parents/members, providers, employees, and pharmacy students.
• Performs other essential functions.

Skills & Requirements

• Bachelor's Degree Science in Pharmacy OR Pharm. D. Doctor of Pharmacy required
• RPH - Pharmacist by the State of Texas required
• 3 years Managed care experience at a health plan or PBM working in utilization management, analytics, formulary management, and/or clinical literature required
• 1 year Managed Care Pharmacy Residency experience preferred
  

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.

Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.