We’re unique. You should be, too.
We’re changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?
We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team.
The Clinical Review Pharmacist works to ensure that ChenMed members have access to all medically necessary prescription drugs, and those drugs are used in a cost-effective, safe manner. The incumbent completes prior authorizations for internal expert peer discussions (EPD) on high-cost medications to control appropriate medication use, following guidelines created by the organization. Additionally, they are involved in formulary management (such as reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services (such as therapeutic drug monitoring, drug regimen review, patient education, and medical staff interaction), and oversight (establishing and measuring performance metrics regarding patient outcomes, medications safety and medication use policies).ESSENTIAL JOB DUTIES/RESPONSIBILITIES:
- Reviews coverage determinations and appeals in a timely, compliant, and accurate manner.
- Ensures compliance with the coverage determination and appeals process.
- Acts as a liaison between ChenMed and its patients with respect to the clinical guidelines we practice.
- Serves as the formulary expert for the therapeutic class they are reviewing.
- Contributes to projects aimed at improving STAR ratings, HEDIS, CAHPS, and other quality metrics.
- Assists with clinical questions and phone calls from prescribers, pharmacies and/or ChenMed members.
- Develops, implements and maintains pharmacy cost control and quality initiatives under the direction of leadership and guidelines.
- Monitors drug utilization and assists Pharmacy leadership team in understanding quality and cost control issues.
- Acts as a liaison between ChenMed and its members with respect to the pharmacy benefits.
- Works with providers to ensure accurate coverage determination decisions.
- Performs outreach to patients and providers as part of quality and/or cost control initiatives.
- Performs other duties as assigned and modified at manager’s discretion.
- Excellent analytical and deductive reasoning skills; detail oriented
- Good judgement and problem-solving skills
- Knowledge of and experience with state and federal insurance programs
- Familiarity with appropriate local, state, and federal pharmacy laws and regulations
- Ability to work effectively independently and as part of a team
- Ability to communicate effectively with staff, management, executives and patients/members
- Strong organization and time management skills and multi-tasking abilities
- Written and verbal fluency in English; bilingual preferred
- Proficient in the use of Microsoft Office products such as Outlook, Excel, Word and PowerPoint
- Willingness to travel locally up to 50% of the time; flexible to work evening, weekends and/or holidays as needed
- This job requires use and exercise of independent judgment
- Doctorate of Pharmacy (PharmD) required
- Must have a License that is in good standing
- Minimum one (1) year of pharmacy experience
- Minimum one (1) year of utilization review experience preferred
- Pharmacy residency training is preferred, but not required
- Experience in a managed care setting (HMO, MSO, PBM) is a plus
- Medicare Part D or Medicaid experience, along with managed care experience
PAY RANGE:
$118,062 - $168,658 SalaryThe posted pay range represents the base hourly rate or base annual full-time salary for this position. Final compensation will depend on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for a bonuses or commissions.
EMPLOYEE BENEFITS
https://chenmed.makeityoursource.com/helpful-documents
We’re ChenMed and we’re transforming healthcare for seniors and changing America’s healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We’re growing rapidly as we seek to rescue more and more seniors from inadequate health care.
ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people’s lives every single day.
Current employees, if you want to apply to our internal career site, please click HERE
Current Contingent Worker please see job aid HERE to apply
#LI-HybridSkills Required
- Doctor of Pharmacy (PharmD)
- Active pharmacist license in good standing
- Minimum one (1) year of pharmacy experience
- Proficient with Microsoft Outlook, Excel, Word, PowerPoint
- Familiarity with local, state, and federal pharmacy laws and regulations
- Knowledge of and experience with state and federal insurance programs
- Written and verbal fluency in English
- Willingness to travel locally up to 50% and work flexible hours (evenings, weekends, holidays)
- Ability to exercise independent judgment and work both independently and on a team
- Minimum one (1) year of utilization review experience
- Pharmacy residency training
- Experience in a managed care setting (HMO, MSO, PBM)
- Medicare Part D or Medicaid experience
- Bilingual (preferred)
ChenMed Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about ChenMed and has not been reviewed or approved by ChenMed.
-
Healthcare Strength — Benefits include multiple medical, dental, and vision options, wellness incentives, and an Employee Assistance Program. Feedback suggests these health offerings are seen as a strong component of the total package.
-
Retirement Support — A 401(k) with company match and financial wellness resources are emphasized. Feedback suggests the retirement program is viewed as competitive, with match and vesting details commonly highlighted.
-
Parental & Family Support — Paid parental leave at 100% for up to four weeks and up to 10 days of backup child/adult care are provided. Feedback suggests these family supports add meaningful flexibility and security.
ChenMed Insights
What We Do
ChenMed brings concierge-style medicine and better health outcomes to the neediest populations – moderate-to-low income seniors with complex chronic diseases. Operating over 50 medical centers in eight states, we are known to our patients as Dedicated Senior Medical Center, Chen Senior Medical Center, or JenCare Senior Medical Center. Through our innovative operating model, physician-led culture and empowering technology, we drive key quality and cost outcomes that create value for patients, physicians and the overall health system. By recruiting focused physicians and reducing their doctor-to-patient ratios, we increase patients’ “face time” during each monthly appointment and help foster stronger doctor-patient relationships. Results of our high-touch approach to primary care are impressive, as illustrated in the recent Modern Healthcare cover story published on Oct. 20, 2018, which reports that: “Indeed, ChenMed's approach has resulted in 50 percent fewer hospital admissions compared with a standard primary-care practice, 28 percent lower per-member costs, and significantly higher use of evidence-based medications.”
