Director, Clinical Pharmacists
Company: Magellan Health
Location: Rancho Cordova
Posted on: October 9, 2021
Job Description:
Provides oversight for policy implementation and utilization
management services. Develops and sustains an interface with client
forums, facilitates the delivery of appropriate care and
contributes to the development of the clinical mission of the
business, including the development, implementation, and evaluation
of clinical programs.
- Directs the utilization review process and oversees the quality
of utilization determinations.
- Responsible for the quality of the utilization review
determinations.
- Develops and implements a utilization management program and
action plan.
- Oversees the appeals process. Responsible for the development
of the appeals procedures.
- Continuously reviews staff resources to meet contractual
service levels.
- Ensures compliance with clinical goals through regular
monitoring of center performance.
- Evaluates the effectiveness of the clinical program and
modifies programs as needed to achieve desired results.
- Provides clinical leadership, oversight, and consultation for
Quality Improvement (QI) Program and the Utilization Management
(UM) Program including monitoring effectiveness and compliance with
goals, prevention programs, network development and management,
quality of care concerns and adverse incidents, medical practice of
network or sub-capitated providers, clinical service delivery
system, coordination with After Hours Team and oversight of
clinical appeals.
- Works collaboratively with QI on the development and
implementation of QI activities, UM and QI program descriptions,
evaluations, and work plans.
- Implements and interprets pharmacy policy for the contact
center, including but not limited to Medical Necessity Criteria and
Clinical Practice Guidelines.
- Recruits, trains, supervises, mentors, oversees and evaluates
the quality of clinical staff and physician advisors.
- Ensures adequate physician advisor resources.
- Potentially makes outbound or takes inbound telephone calls to
assist in various aspects of patient care and/or product
distribution to/from practitioners, members, and pharmacies. These
calls include, but are not limited to, comprehensive medication
reviews, targeted medication reviews, call to practitioners about
product awareness, and prior authorizations.
Other Job
Requirements
Responsibilities
Pharmacy Benefits Management (PBM) experience required.
Strong drug product and clinical pharmacy knowledge.
General Job
Information
Title
Director, Clinical Pharmacists
Grade
31
Work Experience - Required
Pharmacy
Work Experience - Preferred
Education - Required
PharmD - Pharmacy
Education - Preferred
License and
Certifications - Required
PharmD - Doctor Of Pharmacy, State Licensure - Pharmacy
License and
Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity
Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the
security responsibilities and security controls unique to their
position; and comply with all applicable legal, regulatory, and
contractual requirements and internal policies and procedures.
Keywords: Magellan Health, Rancho Cordova , Director, Clinical Pharmacists, Other , Rancho Cordova, California
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