Pharmacy Clinical Consultant

Build a career with purpose. Join our

Who We Are Looking For:

Every day, Cambia's dedicated team of Pharmacy Clinical Consultants are living our mission to make health care easier and lives better. As a member of the Health Service Organization on the High Cost team, our Pharmacy Clinical Consultant is a pivotal position responsible for designing, implementing, assessing, and maintaining clinical programs and strategies that drive cost containment and clinical quality enhancements related to pharmacy services. This role involves close collaboration with internal stakeholders to ensure seamless alignment with care management, provider engagement, and member engagement strategies - all in service of creating a person-focused health care experience.

Are you a Pharmacist passionate about driving clinical excellence and cost containment in pharmacy services? Are you a healthcare professional looking for a new challenge? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

• Bachelor's degree in a health related field

• 4 years of experience in ambulatory care/hospital/pharmacy benefit management

• Pharm.D. degree and experience in pharmacy benefit management and clinical program development is preferred

• Must be an active and unrestricted licensed pharmacist in state of practice

Skills and Attributes:

• Possesses in-depth knowledge of the pharmacy benefit management industry, including benefit design, pharmacy products and services, and competitive offerings, as well as client needs.

• Demonstrates strong understanding of healthcare economics and financing, industry dynamics, and pharmacy/provider service reimbursement of medications.

• Exhibits strong clinical knowledge and understanding of evidence-based medicine principles, with the ability to apply them to formulary design, medication coverage policies, and other medication management solutions.

• Proven ability to interpret complex clinical information, claims data, and regulatory requirements to develop practical and creative product development solutions.

• Demonstrates leadership and interpersonal skills, with the ability to effectively manage projects and vendor relationships.

• Possesses excellent verbal and written communication skills, strong business analytical skills, and project management and coordination abilities.

• Proven success in managing professional business relationships in the healthcare delivery industry, including managed care systems, medical groups, and hospitals.

• Familiarity with health plan and benefit design structures, Medicare/CMS regulations, and pharmaceutical products, including orals, injectables, infusion products, and chemotherapy.

• Knowledge of healthcare coding and payment systems, such as ICD-10, CPT, HCPCS, and NDC.

• Understanding of state and federal laws and rules regarding pharmacy practice and healthcare industry regulations, including DOLI, PPACA, and HIPAA.

• Familiarity with compliance-related activities, legislative and regulatory activities, health insurance operations, and legal research is desirable.

What You Will Do At Cambia:

• Lead the identification of clinical areas for product development and execute clinical programs to meet member needs, including pilots with strategic partners.

• Stay abreast of industry trends and market differentiating clinical strategies to maintain competitive knowledge.

• Analyze utilization trends and quality outcomes, providing creative solutions to support cost containment, quality improvement, and regulatory compliance.

• Evaluate and select vendor clinical offerings that align with Regence's clinical and business goals, and negotiate, monitor, and manage vendor performance.

• Contribute to pharmacy clinical strategies, formulary development, policy development, benefit design, and utilization management initiatives.

• Regularly assess and refine clinical product offerings to maintain a competitive portfolio with strong ROI, and design/improve clinical and operational processes to support exceptional member experiences and operational efficiency.

• Provide consultative expertise to strategic partners, plan leadership, purchasers, and other stakeholders, and mentor/coach pharmacy students and residents as needed.

• Provide consultative expertise and coaching to internal RN and SW case managers, attend clinical rounds when appropriate to support care management process and initiatives.

#LI-Remote