Clinical Pharmacist - SCAN Temp

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 277,000 members in California, Arizona, Nevada, Texas and New Mexico. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 45 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare.

SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.

Job Description : The Job

The Clinical Pharmacist - SCAN Temp will play an instrumental role in ensuring compliance and clinical appropriateness of Part D coverage determinations, appeals and grievances, and Part C organizational determinations for a senior-focused Medicare Advantage Plan. The Clinical Pharmacist will work alongside the Director to execute and ensure CMS compliant operations and strong star rating performance for these areas. In addition, the Clinical Pharmacist will support Interdisciplinary Care Team work, and complete medication-related clinical reviews to support the care management teams at SCAN. The Clinical Pharmacist will participate in other managed care responsibilities as assigned. This position reports into the Manager, Pharmacy Experience & Access.

You Will

Serve as a subject matter expert of Part D coverage determinations, redeterminations, and applicable Part C organizational determinations.

Utilize Medicare Part D knowledge and expertise to ensure compliance and clinical appropriateness with coverage determinations, appeals, and grievances.

Maintain current knowledge of relevant Medicare Part D regulations by participating in CMS calls and reading released guidance and implementing changes / updates to maintain compliance.

Produce and maintain Prior Authorization criteria and Step Therapy criteria in accordance with CMS requirements on monthly and annual basis Maintain professional and technical knowledge by attending educational workshops. Develop and maintain formulary exception criteria.

With direction from the Manager, develop, coordinate and implement an effective on-going strategy to achieve strong star ratings and audit readiness for assigned functions.

Serve as the clinical appropriateness subject matter expert during regulatory audits.

Ensure rigorous daily monitoring of operations for compliance performance 8 Contribute in quality improvement and process enhancement projects internally and with contracted PBM.

Foster strong relations with internal departments and contracted PBM.

Serve as pharmacy expert on Interdisciplinary Care Team, other committees, and workgroups as required.

Support the care management teams by reviewing records of patients to determine the appropriateness of medication therapy, consulting on dosages, and collaborating with healthcare professionals to ensure optimal patient care. Serve a clinical bridge to the Formulary & Benefits team on effectiveness and considerations for additional formulary utilization management strategies

We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.

Actively support the achievement of SCAN's Vision and Goals.

Other duties as assigned.

Your Qualifications

3-5 years of related experience .Performs work under minimal supervision

Bachelor's Degree or equivalent experience.

Handles complex issues and problems, and refers only the most complex issues to higher-level staff.

Possesses comprehensive knowledge of subject matter .Provides leadership, coaching, and / or mentoring to a subordinate group.

Ability to work as part of a team.

Ability to foster teamwork.

Decision-making skills.

Strong oral and written communication skills.

Ability to build collaborative relationships.

Customer / client orientation.

Detail oriented.

Required technical skills : Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams), Visio.

What's in it for you?

This is a temporary opportunity for a limited period of time

Base Pay Range : $106,200 to $153,705 per year

Work Mode : Hybrid (requires onsite presence twice per week)

Medical Benefits

Paid Sick Time

Excellent 401(k) Retirement Saving Plan

Robust employee recognition program

An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

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Equal Opportunity Employer / Protected Veterans / Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)