Health Plan Clinical Pharmacist

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together. This position is responsible for performing and/or supervising clinical pharmacist activities related to Pharmacy Quality Initiatives (i.e. MTMP, Adherence, CPAS, vHTN, ePA, etc.) for Kelsey-Seybold Clinic and/or KelseyCare Advantage. The clinical pharmacist works collaboratively with healthcare providers to ensure patients are receiving the proper medications and dosages for the patient's condition. The clinical pharmacist performs medication reconciliation, counsels patients on medications & chronic disease states, conducts thorough chart reviews, addresses medication-related problems, develops effective medication plans & follow-up coordination, and documents accurately within the electronic medical records. The clinical pharmacist is responsible for the comprehensive understanding of program protocols, current clinical guidelines, and medication administration expertise in various populations; as well as, responsible for utilizing excellent communication skills, achievement of customer service objectives, compliance to organizational policies & procedures, and adherence to professional practices.

Responsible for conducting clinical pharmacy services through Pharmacy Quality Initiative Programs. During these encounters with members the following will be conducted: review of all current medications, review pharmacy claims in contracted PBM systems, drug-drug interactions screened, therapeutic alternatives recognized, communication with physician regarding drug therapy, patient counseling, medication reconciliation within EPIC (medical chart) and follow-up with member Answer inbound calls and conduct outbound calls regarding processing of coverage determinations. Review medical information essential for coverage determination to be conducted. Properly enters data into software program(s). Enter overrides in appropriate systems to process payment. Generates letters and/or reports Works all appropriate program workflow steps and queues as assigned. After hours/weekend coverage as assigned Communicate with physicians and other healthcare personnel to discuss specific medication recommendations, therapies for cost-effective care, general drug information, and educate about health plan prescription drug benefits Monitors and evaluated claims for appropriate use by members, physicians and pharmacies. Conducts drug utilization review of potentially fraudulent claims, abuse, and/or waste. Assists in reviewing claims adjudicated by the PBM to ensure payment for formulary products are processed correctly. Perform audits. Reports risks to management Communicates instructions to internal and external individuals and/or departments. Furnishes and obtains information from other entities/vendors. Maintains staffing and program schedules Assists in the development of clinical pharmacy program enhancement and better practices within the department including but not limited to RX Quality Initiative (RXQI), Pharmacy Quality Initiative Programs (QIP), Adherence Programs, Medication Therapy Management Program (MTMP), Hospital Discharge Program (HDP), Centralized Pharmacy Anticoagulation Service (CPAS), Fraud Waste and Abuse (FWA) protocols, and Coverage Determination (CD) processes Provide program training and oversight. Provide training and oversight of program staff, pharmacy residents and assigned interns as