PHARMACY MEDICAID PROGRAM MANAGER - MANAGED CARE Job Number: 00124433 Job Posting : May 20, 2020, 5:34:28 PM Closing Date : Jun 4, 2020, 4:59:00 AM Full-time A.M. P.M. Collective Bargaining Unit: None Posting Salary: COMPETITIVE SALARY Organization: Health and Hospital Systems JOB SUMMARY
LOCATION: 600 W. Jackson Blvd., Chicago, IL. 60661 SHIFT: DAY Under the direction of the Director, Pharmacy Services, the Pharmacy Medicaid Program Manager is responsible for assisting pharmacies, physician offices, and internal stake holders in the timely and effective provision of pharmaceutical products and services to County Care Health Plan members. The Pharmacy Medicaid Program Manager serves as patient advocate when giving direction in the planning and implementation of pharmaceutical care by considering the patient's disease condition, age background, need for understating and participation in drug therapy in a fiscally responsible manner. The Pharmacy Medicaid Program Manager is responsible for consultation of safe, effective, and cost-effective use of drugs through the application of specialized knowledge, skills and professional judgement. Additional responsibilities include, but are not limited to, evaluation of drug utilization information, provision of information on formulary programs, providing education on clinical programs, and serving as a drug information resource.
This position is exempt from Career Service under the CCH Personnel Rules. Typical Duties - Assesses pharmacy products and services for health plan members to ensure optimum outcomes, cost effectiveness, and compliance with all state and federal regulations and guidelines
- Participates in the development/ administration of programs designed to enhance the utilization of targeted drugs and the identification of cost saving pharmacy practices
- Develop/ maintain pharmacy programs i.e., Medication Therapy Management, Adherence initiatives, generic conversion initiatives, etc. Acts as a resource to others
- Work closely with Interdisciplinary Care Team to identify barriers and improve compliance with prescribed chronic disease medications
- Participate in development of educational lectures and materials for clinical staff.
- Review Medicaid and Medicare prior authorization requests and make determinations for drug products according to member benefits and coverage criteria
- Serves as a liaison between health plan and PBM associates on issues of policies and procedures, clinical criteria justification, define roles and responsibilities to prior authorization/coverage determination decisions and/or during inbound or outbound phone calls
- Consults with and as necessary refers cases to Director of Pharmacy
- Provide PBM oversight and ensure health plan/PBM handles prior authorization/coverage determination requests within all federal and state regulatory compliance time frames
- Project management and process improvement experience, ability to take initiative, and to think globally based on business goals and objectives.
- Knowledge of concepts of formulary and Pharmacy & Therapeutics Committee and clinical programs (e.g., utilization management) and PBM
MINIMUM QUALIFICATIONS: - Bachelor of Science in Pharmacy or PharmD from a college of pharmacy accredited by the American College of Clinical Pharmacy (ACCP) (Must provide official transcripts at time of interview)
- Licensed as a Pharmacist in the State of Illinois or the ability to obtain license prior to starting employment (Must provide proof at time of interview if already obtained)
- Two (2) years of experience providing patient-centered services
- Prior experience working within a Managed Care setting
- Prior experience working with Pharmacy Benefit Manager (PBM) software
- Proficient with Microsoft Office
PREFERRED QUALIFICATIONS: - Board certified in a clinical specialty and/or has completed an accredited residency program in a clinical pharmacy practice (Must provide proof at time of interview)
- Three (3) years of experience within a Managed Care setting
VETERAN PREFERENCE PLEASE READ When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service To take advantage of this preference a Veteran must : -
Meet the minimum qualifications for the position. -
Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, "Are you a Military Veteran?" -
Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation at time of application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11). Discharge papers must list and Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable. OR A copy of a valid State ID Card or Driver's License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing. If items are not attached, you will not be eligible for Veteran Preference VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER'S LICENSE AT TIME OF INTERVIEW. BENEFITS PACKAGE - Medical, Dental, and Vision Coverage
- Basic Term Life Insurance
- Pension Plan and Deferred Compensation Program
- Employee Assistance Program
- Paid Holidays, Vacation, and Sick Time
- You may also qualify for the Public Service Loan Forgiveness Program (PSLF)
For further information on our excellent benefits package, please click on the following link: http://www.cookcountyrisk.com/
MUST MEET ALL REQUIRED QUALIFICATIONS AT TIME OF APPLICATION FILING.
Degrees awarded outside of the United States with the exception of those awarded in one of the United States' territories and Canada must be credentialed by an approved U.S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview. *Please note all offers of Employment are contingent upon the following conditions: satisfactory professional & employment references, healthcare and criminal background checks, appropriate licensure/certifications and the successful completion of a physical and pre-employment drug screen. *CCHHS is strictly prohibited from conditioning, basing or knowingly prejudicing or affecting any term or aspect of County employment or hiring upon or because of anypolitical reason or factor.
COOK COUNTY GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER. |
