Overview

Scope of Responsibilities: Relies on experience and professional judgment to plan, accomplish, and report on assigned tasks and goals that meet the clinical needs of ProAct clients and members.

Job Summary: At the end of the one-year program, the resident will possess knowledge on clinical account management, drug utilization management, data analysis, formulary management, and Medication Therapy Management (MTM). They will be responsible for the execution of clinical programs interacting with patients and prescribers to improve health outcomes while lowering client costs.

Responsibilities

• Identify, develop, and execute clinical and cost savings programs for clients based upon review of utilization data, current trends, and industry offerings. Perform cost avoidance analysis to demonstrate a return on ProAct and/or client investment.
• Perform patient and prescriber outreach to complete clinical interventions, including but not limited to leveraging the following software and programs: PA Hub/PromptPA, Clinical Optimization, Diabetes Management, Medication Therapy Management, and Aprexis.
• Maintain and update clinical criteria associated with prior authorization software as it relates to formulary changes.
• Review prior authorizations and appeals against the formulary and clinical criteria for ProAct members as needed.
• Develop and present educational programs to ProAct clients and other business partners.
• Monitor for compliance with all policies and procedures and regulatory issues impacting role in the organization.
• Leverage available resources (i.e., UpToDate, Clinical Pharmacology, Pharmacist Letter, IPD Analytics, Pipeline/Trend Reporting) to remain current on industry topics.
• Collaborate with the Kinney Patient Care Center on communication and reporting relating to on-site flu clinics for ProAct clients.
• Complete all mandatory KPH, state, and federal training programs.
• Perform other related duties as assigned.

Qualifications

Educational Requirements:

• PharmD Degree from an accredited College of Pharmacy

Compensation:

$60,000 - 65,000 per year.

The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience and education.

KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state and federal regulations as it pertains to minimum wage requirements.