Manage the clinical pharmacy program for AMERIGROUP Georgia Community Care in coordination with the corporate pharmacy department. Develop effective communications regarding pharmacy initiatives and changes, coordinate pharmacy-related materials and mailings to members, providers and network pharmacies, and ensure dissemination of communications to appropriate AMERIGROUP staff. Develop and implement the tools and strategies necessary to evaluate, measure, and manage pharmacy utilization patterns in support of improved medical management and clinical outcomes. Oversight of contractually required reporting for State regulatory audits, compliance monitoring and quality improvement programs. This position reports to the AMERIGROUP Georgia Community Care Chief Medical Officer.
PRIMARY RESPONSIBILITIES:
1) Support AMERIGROUP’s corporate clinical Pharmacy Program initiatives to ensure safe and appropriate pharmaceutical care that achieves optimal cost-effective outcomes for members.
2) Point of contact for all Georgia state regulatory issues concerning pharmacy benefits.
3) Responsible to ensure compliance with all Georgia state contractually required Pharmacy Policy and Procedures .
4) Supports marketing activities by reviewing and updating member and provider material related to the pharmacy program (handbooks, newsletters, etc.)
5) Participates in AMERIGROUP national P&T Committee activities including preparation and presentation of therapeutic class reviews, drug monographs, formulary development, provider education programs and clinical drug policies and procedures. Reports P&T activities and results to the AMERIGROUP GEORGIA Medical Advisory Committee.
6) Interfaces with corporate pharmacy department in identification and resolution of pharmacy benefit design, pharmacy claims processing and pharmacy network issues. Responsible for coordinating state required pharmacy benefit changes with the corporate pharmacy department.
7) Responsible for the AMERIGROUP Georgia Community Care Pharmacy lock-in program.
8) Manage AMERIGROUP Georgia Community Care Pharmacist Advisory Committee
9) Participates in Georgia State DUR Board meetings and any applicable state P&T committee meetings and assures compliance with state Drug Utilization Review standards.
10) Responsible for processing prior authorization requests in compliance with clinical and regulatory policies and procedures.
11) Performs drug utilization review activities in support of medical management initiatives. These activities include, but are not limited to, analysis of unit costs, formulary compliance, generic substitution rates and drug mix analysis.
12) Performs retrospective drug utilization review in support of provider prescribing profiling and implements a provider education, academic detailing program.
13) Collaborates with other departments to incorporate pharmacy protocols into disease management and case management programs and other clinical programs.
14) Develops relationships with local colleges of pharmacy to sponsor clerkship programs and manages the performance and productivity of students.
15) Responsible for providing clinical drug expertise for Georgia medical staff.
16) Attends local, regional or national conferences as needed
17) Travel required to support clinical programs
18) Other duties as requested or assigned.
EDUCATION AND EXPERIENCE:
Education
Required: BS in Pharmacy
Preferred: Doctorate of Pharmacy
Years and Type of Experience
Required:
1. Two years Pharmacy Managed Care experience
2. Ability to evaluate clinical data and develop strategies to enhance Pharmaceutical Care
Preferred:
Specific Technical Skills
Required:
Preferred:
Certifications or Licensure
Required:
1. Must have a valid driver’s license and access to a motor vehicle.
2. Current, unrestricted Georgia Pharmacist License
Other
Required:
1. Proven ability to communicate with providers
2. Excellent communications and presentation skills.
3. Proven problem identification and solving abilities.
4. Strong analytical abilities.
5. Ability to organize, prioritize and complete multiple tasks and projects and meet deadlines.
6. Proven ability to facilitate meetings.
7. Knowledge of provider compensation issues.
8. Familiarity with provider organizations.
9. Excellent oral and written communication skills
10. Working knowledge of word processing, spreadsheet and presentation applications.
11. Knowledge of federal and state healthcare regulations.
12. Appreciation of cultural diversity and sensitivity towards target population.
SCOPE INFORMATION
Item Measure
1. # Direct Reports undetermined
2. # Indirect Reports undetermined
3. Budgetary $ Responsibility Total Plan Pharmacy Budget, (driven by member metrics)
PHYSICAL REQUIREMENTS
1. Must be able to operate a computer.
2. Must be able to operate a telephone.
3. Must be able to travel on common carrier and adhere to AMERIGROUP’s travel policies.
For immediate consideration send your resume here.