Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.
Job Description• Works in the community to build and maintain strong relationships with key figures with an effort to provide best in class health care to the members.
• Focus areas include DTM, tracking results, program enhancements, pharmacy queue improvement, care gaps, and reviewing PBM policies and procedures for compliance with applicable state requirements.
• Reviews clinical/financial recommendations and strategies provided by the clinical pharmacists to determine feasibility and appropriateness for clients and ensure flawless implementation of these initiatives. Monitors each of the initiatives to measure results.
• Monitors CLIENT pharmacy trends; makes recommendations for process, product, and program improvement; plans, implements, and monitors changes.
• Supports CLIENT medical management goals by being a point person for the implementation of all pharmacy-related clinical program initiatives.
• Provides support and attends all pharmacy-related meetings and committees sponsored by the health plans, representing CLIENT and participating on the plan's P&T Committee.
• Keeps abreast of industry trends and regulatory changes in the pharmacy industry and evaluates their effect on pharmacy contracts and services.
• Provides on-site education and training for CLIENT providers on applicable processes and procedures.
• Develops strategies along with our PBM partners to improve HEDIS ratings and other quality measures.
• Participates in onsite visits to hospital systems, selected physician group practices, and pharmacies.
• Acts as the main point of contact for physicians and plan staff experiencing problems with the pharmacy program (decisions, process, timeliness, etc.).
• Supports Fraud and Abuse program system oversight. Communicates any suspected fraud discovered by the contact center staff. Recommends course of action for providers where patterns appear outside of guidelines and generally accepted pharmacy standards.
• Provides on-site consultation and education to nurses, case managers, and/or physicians.
• Coordinates with CLIENT Compliance team on key operational and medication management issues identified through plan oversight and monitoring of PBM.
• Develops/builds relationships with local behavioral health providers, Perform Care staff, and clients with the goal of improving the delivery of health care programs.
• Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity.
Qualifications• Either PharmD or RPh appropriate. Must be licensed in DC and locally based. Required.
• 3 to 5 years of clinical pharmacy experience in a managed care setting.
Additional InformationWe do have a referral bonus of $500 per candidate if you refer any of your friends or colleagues who are looking for the same job.
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