Pharmacist

• Help develop and implement Monogram’s medication therapy management (MTM) program
• Perform timely written member medication reconciliations and drug therapy action plans
• Conduct telephonic consultations with medical providers
• Collaborate with clinical care manager operations personnel
• Serve as a pharmacist resource for Monogram field clinicians
• Assist with the development and delivery of MTM training sessions
• Monitor important medication availability and use trends
• Stay current with evidence-based prescribing for individuals with kidney disease
• Participate in interdisciplinary care team case rounds or meetings
• Implement medication optimization processes

Clinical Pharmacist

Pharmacist, Automated Dispensing Unit – Long Term Care – Part Time

• Responsible for support and input to clinical programs such as: Health Management, Drug Utilization Review, Formulary development, and Prior Authorization programs to encourage appropriate, high quality, cost effective drug therapy; and to identify opportunities for improvement in efficiency, accuracy, and appropriateness of the programs in place
• Participate in the Coverage Determination (Certification, Prior Authorization, Medical Exception, Exception to Coverage, etc.) process by reviewing all requests which are not clearly approvable based on specified criteria (algorithms), making all coverage denial determinations, and identifying themselves by first name, title, and responsibility at Navitus in relation to drug utilization management program administration
• Continually monitor the quality and efficiency of the Coverage Determination process including coverage criteria, denial language, and communication with prescribers
• Provide input to clinical content of new programs and for maintenance of existing programs
• Complete all annual URAC training requirements
• Facilitation of communication and education to clients, members, and internal staff regarding clinical daily issues and objectives
• Provide support to operational departments on the implementation of various PBM programs and daily functioning in support of member/patient quality of care
• Responsible for supporting / providing clinical expertise related to formulary decisions made by the Pharmacy and Therapeutics committee
• May review health care survey data for Medicare Part D qualified participants and/or perform phone consultations with Med-D enrollees; aid in documentation of calls; designate enrollees for repeat interaction
• Other duties as assigned

Pharmacist I – Clinical Prior Authorization

• Optimize patient outcomes through telephonic interventions
• Focus on the tactical execution of medication management services, including polypharmacy, adherence, and pharmacotherapy optimization
• Counsel patients via telephonic outreach on medication adherence, address any medication related problems such as adherence barriers, polypharmacy, or high risk medication use, and make appropriate evidence-based recommendations to patients and Practice Care Teams
• Perform focused clinical chart reviews as needed to inform patient interventions
• Obtain and document patient commitment to medication adherence and address barriers in real time
• Escalate complex clinical cases to prescribers or interdisciplinary teams as appropriate
• Meet and sustain performance goals (e.g., STARs, HEDIS)
• Collaborate with Physicians, clinical and administrative staff to optimize the Medication Management workflow and patient experience
• Proactively identify gaps in medication management through patient interactions and translate patient insights into targeted recommendations that drive improvements in practice operations and clinical workflows
• Participate in the design, implementation, and evaluation of pilot programs or process changes (“test and learn”) within the outreach model
• Serve as a clinical subject matter expert, leveraging clinical pharmacy expertise to support organizational objectives and adapt to evolving healthcare needs
• Develop and maintain standardized resources, educational tools, and clinical protocols to support improved medication outcomes and performance on quality measures (e.g., STARS, HEDIS) for practices, clinicians, and patients

Clinical Pharmacist, Pharmacy Outreach

• Operate within pharmacist-led clinical programs focused on chronic disease, quality improvement, and medication optimization.
• Activate on provided lists of eligible patients by outreaching, enrolling, and engaging patients. Maintain engagement through education, outreach, and follow-up.
• Conduct Medication Reconciliation, Medication Therapy Management (MTM), and Comprehensive Medication Reviews (CMR).
• Provide telephonic patient education on medication use, adherence, self-management, and escalation of care.
• Provide specific actionable medication recommendations and collaborate with providers, using technology and direct communication, to support practice adoption and medication management.
• Support other clinical programs to provide periodic consultation on pharmacy related issues affecting patients
• Drive medication adherence to address quality gaps
• Collaborating with the IDT—which includes primary care physicians, health coaches, and nursing staff—to develop patient-specific clinical action plans, reconcile medications, and make necessary adjustments to medications.
• Accelerate adoption of clinical insights by providers by driving uptake of actionable drug-related recommendations.
• Provide clinical feedback to enhance decision support logic, usability, and impact.
• Collaborate with Regional Medical Officers, Market Medical Directors, Practice Transformation Managers, care teams, and practices.
• Support consistent clinical standards, workflows, and messaging across markets.
• Support ideation and development of initiatives related to specialty medications, high-cost drugs, and pharmacy optimization programs.
• Partner with pharmacy and medical leadership on drug strategy aligned with value-based care goals.
• Document all clinical activity accurately and in accordance with state and federal regulations and HIPAA requirements, using provided platforms and technologies
• Serve as a pharmacy information resource for providers and internal clinical teams.
• Remain current on clinical guidelines, quality measures, and pharmacy best practices.

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Clinical Pharmacist

Pharmacist, Automated Dispensing Unit – Long Term Care – Part Time

Pharmacist I – Clinical Prior Authorization

Clinical Pharmacist, Pharmacy Outreach

Clinical Pharmacist