Population Health Clinical Pharmacist - Utilization Management/Prior Authorization

We are so glad you are interested in joining Sutter Health!

Organization:

SHSO-Population Health Services-Valley

Position Overview:

Delivers pharmaceutical care services at the patient/member and population level through the provision of clinical services, medication literature evaluation and drug information services, utilization reviews and coverage determinations in accordance with applicable state and federal laws and regulations, patient and provider education. Analyzes large data sets to identify and execute on strategies that improve medication use across the care continuum. Exercises sound judgment and developed clinical skills to provide input to and implement the patient's plan of care based on the health status and risk factors. Gains confidence and cooperation from the patients and caregivers and applicable members of the healthcare team to improve medication use and health outcomes Adheres to all local/state/federal regulations, codes, accreditation standards, and policies and procedures to ensure privacy and safety while delivering optimal patient care.

Job Description:

EDUCATION:

• PHARMD-Graduate of an accredited pharmacy school

CERTIFICATION & LICENSURE:

• PHARMR-Registered Pharmacist

TYPICAL EXPERIENCE:

• 5 years recent relevant experience

PREFERRED EXPERIENCE:

• Prior Authorizations

• Coverage Determinations

• Integrated Delivery Systems

• Managed Care PBM

SKILLS AND KNOWLEDGE:

• Completion of post-graduate year one (PGY1) residency or 3 years of experience in a managed care or health-system environment

• Knowledge of medical terminology, generic and trade pharmaceutical names, pharmaceutical calculations and laws and regulations.

• Knowledge and understanding of different Pharmacy practice settings, including narcotic delivery and procedures.

• Knowledge and ability to identify and employ pharmaceutical and medical terms, abbreviations and symbols commonly used in prescribing, dispensing, and record keeping of medications.

• Requires a basic working knowledge of legal requirements and accreditation standards including The Joint Commission, Title XXII, Department of Homeland Security, Drug Enforcement Administration, Food and Drug Administration, and United States Pharmacopeia.

• Possess written and verbal communications skills to explain sensitive information clearly and professionally to diverse audiences, including non-medical people.

• General knowledge of computer applications, such as Microsoft Office Suite (Word, Excel and Outlook), related pharmaceutical technology, electronic health records (EHR), and EPIC.

These Principal Accountabilities, Requirements and Qualifications are not exhaustive but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development).

Job Shift:

Days

Schedule:

Full Time

Shift Hours:

8

Days of the Week:

Monday - Friday

Weekend Requirements:

None

Benefits:

Yes

Unions:

No

Position Status:

Non-Exempt

Weekly Hours:

40

Employee Status:

Regular

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $85.59 to $103.06 / hour

The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.