Specialty Practice Pharmacist - OSU Health Plan

Scope of Position

This position serves as a Specialty Practice Pharmacist for The Ohio State University Health Plan clinical programs and reports to the Director of Pharmacy and Integrated Care Networks. The Specialty Practice Pharmacist is responsible for achieving clinical and operational excellence as it relates to OSU Health Plan medical/pharmacy benefits and clinical programs (i.e., Comprehensive Medication Management, Disease Management, Utilization Management, Formulary Management, Drug Information, Benefit Design, Population Health). The Specialty Practice Pharmacist serves as a member of the service team responsible for developing, executing, evaluating, and promoting care management programs for university health plan members and affiliated groups. The Specialty Practice Pharmacist works collaboratively with directors, managers, and clinicians to ensure delivery of innovative, cost-effective, high quality and personalized health care services in an accessible, patient-friendly focused atmosphere. The Specialty Practice Pharmacist acts as a resource to other pharmacy and care management program staff and as a qualified preceptor for the health plans accredited Managed Care Pharmacy residency program.

Position Summary:

The Specialty Practice Pharmacistmaintains knowledge of state and national health care trends and proactively responds with initiatives to enhance provision of care and ensure efficient resource utilization;creates, executes, and evaluates health plan clinical programs with an emphasis on improvement in outcomes, service, operations, and cost; develops and implements clinical guidelines and departmental policies and procedures; craftsmedication use evaluations and medication criteria; implements step therapies, prior authorizations, quantity limits, and benefit exclusions as aligned with best practices; serves as a resident and student preceptor; supports the quality improvement manager and clinical staff in resolving appeals, disputes, grievances;collaborates with the Health Plan Medical Director and Director of Pharmacy and Integrated Care Networks to ensure quality programs and appropriate medical/pharmacy benefit application and claim payments.

The Specialty Practice Pharmacist utilizes in-depth conceptual and practical disease state knowledge to evaluate moderate/high-risk cases involving acute/chronic conditions and complex psychosocial needs; works in partnership with the Health Plan Medical Director to optimize the quality of care and manage costs associated with our highest-cost plan participants;maintains advanced knowledge of current and emerging medical treatment modalities and best practice guidelines in diabetes, oncology, hematology, immunology, inflammatory conditions and rare diseases with the ability to analyze and interpret clinical and benefit coverage interrelationships; exercises superior clinical process, critical thinking, and problem solving skills to collaborate with members, providers, practice managers, and internal clinicians to solve complex benefit issues in an accurate and timely manner and ensure plan participants receive high level care throughout the care continuum; collaborateswith medical director to craft and defend medical necessity decisions that adhere to evidence-based practices; leadsthe development, execution, and evaluation of optimal, evidence-based clinical plans;explains difficult or sensitive information to patients and providers while working to build consensus on treatment plans; effectively and efficiently documents treatment plans and outcomes; works independently with guidance only in complex situations; finds creative solutions to address healthcare needs. This position will have a high emphasis on diabetes, weight management, cardiovascular health, renal health, and metabolic dysfunction associated steatohepatitis.

MINIMUM REQUIRED QUALIFICATIONS
Bachelor's Degree in Pharmacy. Registered Pharmacist. 0 years of relevant experience required. 0-2 years of relevant experience preferred.