Job Description
HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products. Our MSO employs 170+ skilled professionals dedicated to ensuring members have access to the highest quality of care while efficiently utilizing healthcare resources.
HCP’s vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities. We pride ourselves on selecting the most qualified candidates who reflect HCP’s mission of serving our members by facilitating the delivery of quality care. Interested in joining our successful Garden City Team? We are currently seeking a
Clinical Pharmacist in our Garden City Office! Position Summary: The Clinical Pharmacist at a healthcare-managed services organization plays a crucial role in ensuring optimal medication management and improving patient outcomes. This position involves reviewing prior authorization requests, evaluating pharmacy utilization, performing medication reconciliation, assisting members with medication adherence, and managing medications for chronic conditions. The Clinical Pharmacist will also assess medications for high-risk members enrolled in case management and for members with recurrent hospital admissions. This role will also assess the appropriateness of sites of service for medication administration, serve as a clinical pharmacy resource for other departments, and contribute to achieving high performance on quality pharmacy measures. Additionally, the Clinical Pharmacist will explore opportunities for improved pharmacy utilization, promote the use of biosimilars when appropriate, review specialty medications, and identify cost-containment strategies. Finally, this role will educate and train pharmacy technicians, providers, and members regarding medication management.
Essential Position Functions/Responsibilities: - Review prior authorization requests for medications to ensure appropriateness, safety, and cost-effectiveness
- Assess clinical information and evidence-based guidelines to make informed decisions regarding medication approvals
- Evaluate pharmacy utilization patterns to ensure medical necessity and optimize medication therapy
- Identify opportunities for cost savings and recommend appropriate interventions, such as formulary changes and generic medication conversions
- Perform medication reconciliation for members to prevent medication errors and ensure continuity of care, including after hospital discharge and as needed for care management
- Collaborate with healthcare providers and patients to update medication regimens and resolve discrepancies
- Review member-specific treatment plans to identify areas of opportunity for improving blood pressure and diabetes management.
- Assist members in improving medication adherence through patient education, counseling, and developing personalized medication plans
- Collaborate with care management teams to address barriers to adherence and promote medication self-management
- Provide comprehensive medication management services to members with chronic conditions such as CHF and uncontrolled diabetes
- Collaborate with providers to optimize medication therapy, monitor treatment response, and adjust medications as needed
- Remains current with and monitors all State, Health Plan, NCQA, and other regulatory bodies to ensure compliance with the Clinical Services Department
- Serve as a clinical pharmacy resource for other departments, including Quality and Marketing
- Attend rounds and interdisciplinary meetings to provide expert pharmacy input on inpatient and SNP members
- Contribute to achieving excellent performance on quality pharmacy measures, such as statin use in diabetes or cardiovascular disease
- Identify areas for improvement and collaborate with the healthcare team to implement strategies to enhance medication-related outcomes
- Review specialty medications, including those for transplant and oncology, for appropriateness and cost-effectiveness
- Collaborate with providers, specialty pharmacies, and members to ensure optimal therapy outcomes
- Identify opportunities for cost containment through formulary non-compliance interventions and brand-to-generic medication conversions
- Monitor formulary compliance and work with the pharmacy team to implement cost-effective medication strategies
- Educate healthcare providers and members on medication management, adherence strategies, and potential drug interactions
- Develop educational materials and participate in training sessions to enhance medication-related knowledge for pharmacy staff, providers, and members
Qualification Requirements:
Skills, Knowledge, Abilities - Clinical pharmacy experience in a healthcare or managed services organization setting is preferred
- Strong knowledge of pharmacy practice guidelines, formulary management, and medication therapy management
- Experience with medication reconciliation, medication adherence programs, and chronic disease management
- Familiarity with specialty medications, including their utilization management and adherence challenges
- Understanding of quality measures related to medication management and pharmacy utilization
- Excellent communication skills to effectively interact with healthcare providers, patients, and interdisciplinary teams
- Strong analytical and problem-solving abilities to interpret and evaluate complex medication-related data
- Ability to work independently, prioritize tasks, and manage multiple responsibilities
- Continuous learning mindset to stay updated with emerging pharmacy practices, guidelines, and regulations
Training/Education: - Doctor of Pharmacy (PharmD) degree from an accredited institution is required
- Current pharmacist licensure in the state of New York
- Completion of a pharmacy residency preferred
Experience: - Minimum of five years of management experience in a managed care environment
- Minimum of three years in medication management
- Experience with pharmacy quality measures
- Experience with utilization management and quality improvement processes
- Experience with claims processes
- Experience with provider/member/staff education
Our website:
HealthCare Partners Base Compensation:
$120,000-$125,000 annually Bonus Incentive: Eligibility based off organizational performance
Benefits: Fully paid Medical & Dental employee coverage + robust benefits package (PTO, 401k, FSA, Tuition Reimbursement, etc.)
Equal Employment Opportunity Statement: HealthCare Partners, MSO is committed to fostering a diverse and inclusive workplace. We provide equal employment opportunities (EEO) to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other protected status under federal, state, or local laws. In compliance with all applicable laws, HealthCare Partners, MSO upholds a strict non-discrimination policy in every location where we operate. This policy applies to all aspects of employment, including but not limited to recruitment, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
Job Disclaimer: The above job description outlines the general scope and responsibilities of the position. It is not intended to be an exhaustive list of duties, skills, or qualifications required. Responsibilities may evolve based on business needs.
Job Tags
Full time, Work at office, Local area