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Who We Are Looking For:
Every day, Cambia’s dedicated team of Clinical Pharmacist Consultant’s are living our mission to make health care easier and lives better. As a member of the Pharmacy Services team, our Clinical Pharmacist Consultant’s you will provide expert clinical guidance and decision-making support, leveraging evidence-based medicine to optimize medication choices for efficacy, safety, and affordability. Key responsibilities include evaluating prior authorization requests, appeals, and retrospective claim reviews, providing coverage recommendations, and serving as a resource for medical directors, case managers, and other staff on clinical, policy, and benefit-related questions and interventions. You will also contribute to strategic planning and implementation of clinical initiatives, such as formulary management, medication therapy management programs, quality initiatives, and integrated pharmacy and case management strategies. Additionally, advanced responsibilities may include analyzing healthcare cost information, developing position papers, creating medication coverage policies, and collaborating on cross-functional projects that impact safety, quality, and affordability of pharmacy benefits. – all in service of creating a person-focused health care experience.
What do you think are the most important factors in optimizing medication choices for efficacy, safety, and affordability? Are you a pharmacist looking to leverage your clinical expertise to drive high-quality, cost-effective pharmacy services? Then this may be the the perfect fit.
What You Bring to Cambia:
Qualifications:
- Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD) or Doctor of Pharmacy (PharmD) or related field
- 3-5 years of experience in clinical acute care/hospital setting
- Equivalent combination of education and experience
- Pharmacy license. Successful completion of a pharmacy residency or advanced degree in health-related field preferred. Must be an active and unrestricted licensed pharmacist in state of practice.
Skills and Attributes:
- Clinical Expertise: Possess a strong clinical pharmacy background, with the ability to demonstrate clinical therapy skills and knowledge in a clinical care setting.
- Communication and Analytical Skills: Excellent verbal and written communication skills, with strong business analytical skills and abilities.
- Managed Care and Industry Knowledge: Proven success in managing professional relationships within managed care systems, medical groups, hospitals, or related organizations, with in-depth knowledge of pharmaceutical products and relevant laws and regulations.
- Healthcare Economics and Financing: Strong understanding of healthcare economics and financing, including healthcare/pharmaceutical industry dynamics and pharmacy/provider service reimbursement of medications.
- Regulatory Knowledge: Familiarity with state and federal laws and regulations governing the practice of pharmacy and healthcare industry practices, including DOLI, PPACA, HIPAA, and Medicare/CMS regulations.
- Compliance and Operational Knowledge: Strong understanding of compliance-related activities, legislative and regulatory activities, health insurance operations, and legal issues, with knowledge of healthcare coding and payment systems.
- Collaboration and Operational Skills: Ability to collaborate as part of cross-functional teams and work independently to prioritize work, meet deadlines, and achieve operational goals.
What You Will Do at Cambia:
- Deliver high-quality pharmacy clinical services for Medication Benefit Management, working independently within established frameworks and guidelines to optimize cost-containment and quality improvement.
- Provide evidence-based clinical decision-making to determine medications with the best value for efficacy and safety, applying best practices and evidence-based medicine processes.
- Develop and provide educational materials and correspondences to providers to inform them about medication coverage choices, comparative effectiveness, and coverage determinations.
- Analyze and interpret healthcare cost information to forecast trends and identify opportunities for quality improvement and cost-effective prescription drug programs, using data from medication utilization reports.
- Present clinical positions on medication analysis in a clear and concise manner, and provide creative thinking and leadership in accomplishing goals of quality improvement and cost-effective prescription drug programs.
- Identify, develop, implement, and track complex cross-functional programs, projects, and initiatives related to the provision of pharmacy benefits that impact safety, quality, and affordability.
- Support the execution and assist in the development and maintenance of clinical programs to meet clinical, market, and member needs, including clinical pilots with strategic partners.
- Empower Case Management to provide comprehensive member support by conducting clinical reviews, responding to questions, identifying trends, and providing education to address medication management opportunities.
#LI-Remote
The expected hiring range for a Clinical Pharmacist Consultant is $119,900 – $162,200 depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 15%. The current full salary range for this role is $112,000 – $184,000.
About Cambia
Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we’re helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.
Why Join the Cambia Team?
At Cambia, you can:
- Work alongside diverse teams building cutting-edge solutions to transform health care.
- Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
- Grow your career with a company committed to helping you succeed.
- Give back to your community by participating in Cambia-supported outreach programs.
- Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.
In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:
- Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
- Annual employer contribution to a health savings account.
- Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
- Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
- Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
- Award-winning wellness programs that reward you for participation.
- Employee Assistance Fund for those in need.
- Commute and parking benefits.
Learn more about our benefits.
We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email [email protected]. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.