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Company: The Judge Group
Location: Orange
Posted on: June 5, 2024

Job Description:

Judge Healthcare is seeking a Pharmacy Program Manager in Orange County, CA!Contracted position: 3+ monthsHours: Full time hours, 40 per weekAs a Pharmacy Program Manager, you?ll play a pivotal role in driving pharmacy initiatives and clinical programs across various lines of business, including Medi-Cal, Medicare, and the Program for All-Inclusive Care for the Elderly (PACE). Your responsibilities will involve research, development, and implementation of drug utilization management strategies. You?ll collaborate with prescribers, pharmacies, and the Pharmacy Benefit Manager (PBM) to ensure clinically appropriate prescribing practices while adhering to formulary guidelines and national clinical practice standards.Key Responsibilities:Data Analysis and Trends:Generate and analyze claims and utilization reports to track drug utilization trends. Identify opportunities for targeted utilization management activities.Drug Utilization Criteria:Develop and update drug utilization criteria based on evidence-based medicine and regulatory guidelines.Stakeholder Engagement:Proactively build and maintain relationships with providers, collaborating closely with prescribers, pharmacies, and care team members.Clinical Programs:Participate in clinical quality improvement programs, including Medication Therapy Management (MTM), Transitions of Care (TOC), interdisciplinary care teams, and PACE.Committee Support:Assist the Pharmacy Director and Manager of Clinical Pharmacists in preparing drug monographs and utilization reports for the Pharmacy & Therapeutics Committee.Prior Authorization and Appeals:Review drug prior authorization and appeals requests using clinical and regulatory guidelines.Policy Adherence:Ensure compliance with regulatory standards and policies.Policy Development:Update existing Pharmacy policies and develop new procedures as needed.Intervention Programs:Collaborate with management to recommend and implement targeted drug utilization intervention programs.Data Integration and Disease Management:Work with the Manager of Clinical Pharmacists and Medical Management on data integration and disease management projects.Polypharmacy Recommendations:Review members? medication profiles and provide evidence-based recommendations to healthcare providers.State Fair Hearings:Serve as the plan representative for State Fair Hearings.Complaint Resolution:Address complaints, grievances, and appeals related to drug utilization.Additional Duties:Complete other drug utilization projects and assignments as directed by the Director or Manager.Qualifications:Education:Doctor of Pharmacy degree.Licensure:Current, valid, unrestricted California State Registered Pharmacist License.Expertise:Strong knowledge of clinical pharmacology and disease states.Preferred Experience:3+ years in a managed care setting, performing drug use evaluation and preparing drug monographs.Skills:Project Management:Ability to manage multiple concurrent projects efficiently.Data Analysis:Proficient in analyzing data and drawing meaningful conclusions.Communication:Clear and concise communication skills, both verbal and written.Software Proficiency:Familiarity with Microsoft Office (Word, Outlook, Excel, PowerPoint) and job-specific applications/systems.For immediate consideration please send an updated resume to Christina Head at Jobble

Keywords: The Judge Group, Orange , Pharmacist, Healthcare , Orange, California

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