Pharmacy Program Manager - Population Health Programs, Pharmacy - Southwestern Health Resources (SWHR)

Education

• Bachelor's Degree in Pharmacy required.
• Doctor of Pharmacy or Pharm D. highly preferred.

Experience

• Require 3 years of Managed Care Clinical Program experience OR other work experience which may include Ambulatory Care clinical experience, P&T committee involvement, or primary clinical consultative job duty which would provide an equivalent background.
• Prefer 1 year of Pharmacy Residency.
• Prefer knowledge of insurance and regulatory body guidelines, processes, and systems as well as working knowledge of pharmacy practices and procedures.
• Prefer experience in Government programs such as Medicare.
• Prefer experience as Prior Authorization Pharmacist and/or experience with Medicare guidelines including reference to National Comprehensive Cancer Network (NCCN) compendia.

Licenses and Certifications

• Pharmacist license from Texas State Board of Pharmacy upon hire is required.
• Board Certified Geriatric Pharmacist (BCGP) Certification highly preferred.
• Medication Therapy Management (MTM) Certification from National Board of Medication Therapy Management (NBMTM) highly preferred.

Skills & Abilities

• Must maintain a working knowledge within clinical data systems, payor systems, and EMR portals.
• Ability to perform basic data analytics function as assigned for instance in platforms such as Excel, Access, and Tableau.
• Must be highly organized and detail oriented.
• Strong verbal and written communications skills required.
• Knowledge of insurance and regulatory body guidelines, process, and systems as well as working knowledge of pharmacy practices and procedures. Government programs experience, such as Medicare is a preferred.
• Ability to handle multiple projects, heavy workloads, and deadlines.
• Customer service-oriented mindset, motivated problem solver, and decision-maker.
• Ability to work collaboratively, professionally, and ethically with internal team members and external partners. Including physician communication both verbal and written.
• Proficiency in computerized pharmacy systems and software applications required.
• Proficiency in EMR documentation.
• Proficiency with Windows-based software application including Word and Excel.

Position Responsibilities

Reporting to the Manager Pharmacy Services, the Program Manager Pharmacy Population Health Programs manages activities, projects, and initiatives designed to promote appropriate, evidence-based medication utilization in a population health setting. The Primary focus for the Program Manager Pharmacy Population Health Programs is within our Medicare populations to close clinical and quality gaps and to promote cost optimization initiatives within our Network.

Position Functions

• Responsible for timely and accurate review of referrals/escalations for pharmacy care management, quality program initiatives, or medication adherence cases. Perform and oversee daily clinical operations for the programs assigned:

Manage the coordination and outcome of prescribed pharmacy care by coordinating with patient health care providers, payors, and other health related resources.

Perform telephonic outreach to targeted members, social workers, and physicians to ensure provision of optimal pharmaceutical care including but not limited to closing quality gaps tied to medications in the Medicare population, improve clinical outcomes, and optimize cost for the member’s care.

Responsible for educating pharmacy technicians on any scripting or procedures for outreach to members, healthcare providers, or pharmacies.

Independently obtain medication history assessments as needed. Provide complete information regarding each medication identified (i.e. drug, dose, route, frequency, indication for PRN, and last dose taken date/time).

Verify medication and medical insurance eligibility information and research as needed with resources available member cost share and/or coverage information.

Verify member allergy information and ensure complete documentation (i.e. substance, allergy category, reaction description) and coordinate medication history assessment with care managers and other health care team members including vendors.

Document the medication and allergy information in the electronic medical record (EMR) accurately and in a timely manner, as indicated.

• Responsible for quality performance of assigned programs:

Ensuring KPIs are developed and monitored timely as well as ongoing quality improvement efforts for the programs assigned.

Work collaboratively with other departments such as Care Transformation, Quality, and Provider Networks to ensure optimal program outcomes.

Responsible for oversight of assigned program intervention documentation and outcomes accuracy and timeliness in appropriate.

Collaborates with Pharmacy leadership and the SWHR teams to ensure performance and delivery of auditing and monitoring of activities for the services provided. database(s).

Lead in development and maintenance of policy and procedure documentation for clinical programs including outreach, technology application updates, and documentation processes.

• Special Project and Leadership Assignments:

Provide support for special projects as well as monitoring and recommendations to division leadership pertaining to area of expertise.

Communicate with vendors, payors, and providers on projects and initiatives. Including reports, status updates, and potential coordination for implementations which may include onsite visits.

• Develop and share provider education materials via written and/or verbal communications. May include development of reports, slides, and newsletter formats.
• On a limited basis provide efficient and accurate Part B clinical drug reviews for categories including, but not limited to: oncology, hematology, infectious disease, biologics, and specialty medications for cross training and backup functions for Utilization Management.

Why Southwestern Health Resources 

As a Southwestern Health Resources employee, you’ll enjoy, comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.

Additional perks of being an SWHR employee:

• Gain a sense of accomplishment by contributing to a teamwork environment.
• Positively impact patients’ quality of life.
• Receive excellent mentorship, comprehensive training and dedicated clinical and administrative leadership resources.
• Enjoy opportunities for growth.

Explore Southwestern Health Resources Careers for more information and to search all career opportunities.

Our Recruitment team invites you to contact us with any questions at recruitment@texashealth.org