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Yale UniversitySee more

addressAddressNew Haven, CT
type Form of workFull-Time
CategoryHealthcare

Job description

Essential Duties

1. Lead the Pharmacy and Therapeutics Committee in clinical and pharmaco-economic review of formulary requests. 2. Perform Drug Class Reviews daily until all classes have been updated, then monthly. 3. Review new drugs and pipeline medications; determine where these drugs will fall under the benefit and present recommendations at monthly P&T Committee meetings. 4. Update clinical criteria and submit coding requests to PBM post P&T Committee meeting. 5. DUR claims analysis performed on a monthly basis. 6. Create rebate alignment strategies and present them at P&T Committee meetings. 7. Participate in disease management programs and hazardous drug management. 8. Development of cost savings programs. 9. Review of medications requiring a Prior Authorization. 10. Ensures adherence to policies and procedures, legal and regulatory compliance including Board of Pharmacy, HIPAA, DEA, USP. Supports organizational and departmental efforts in seeking or maintaining accreditation including Joint Commission and other federal and state agencies related to clinical practice. 11. Provide spending and utilization reviews of Yale Health clinicians in support of prudent and cost-effective drug selection decisions. 12. Develop and maintain an up to date Authorization Review Guide. 13. Perform Clinical Pharmacist duties as needed.

Background Check Requirements

All candidates for employment will be subject to pre-employment background screening for this position, which may include motor vehicle, DOT certification, drug testing and credit checks based on the position description and job requirements. All offers are contingent upon the successful completion of the background check. For additional information on the background check requirements and process visit "Learn about background checks" under the Applicant Support Resources section of Careers on the It's Your Yale website.

Position Focus:

In 1971, Yale University established Yale Health to provide health services to its facility, staff and students through a multidisciplinary health maintenance organization located on campus. Yale Health has more than 42,000 members including students, staff, faculty and their families who come from every state in the country and almost every country in the world and is committed to an inclusive workplace. We are celebrating 50 years of service to the Yale community.

Our state-of-the-art facility at 55 Lock Street, is where our members receive most of their care from our 150+ providers. It is a 144,000 square foot medical facility with over 90 exam rooms, a 24/7 Acute Care Department, a 17-bed inpatient facility with two negative pressure rooms, a diagnostic imaging suite including MR and CT scan, x-ray and ultrasound and a full-service retail pharmacy.

Reporting to the Director of Pharmacy, the Managed Care Pharmacist is primarily responsible for the oversight and management of Yale Health's formulary. The Managed Care Pharmacist works collaboratively with clinicians, pharmacists and support staff to provide seamless, quality care for patients at Yale Health. Responsibilities include:

Primary:
P&T Committee member - Participate in the activities of the Pharmacy & Therapeutics Committee; including clinical and financial reviews of individual drugs, drug classes, formulary development, and development of clinical policies and related metrics.

Formulary management -Develop formulary management strategies related to specific drug coverage, step therapy protocols, quantity limits, and prior authorization guidelines. meet all regulatory guidance on both the medical and pharmacy benefits.

Utilization management - Collaborate with Yale Health medical and pharmacy utilization management staff to evaluate prior authorization requests, as related to member benefits (plan documents), medical necessity, site of service, and evidence-based clinical guidelines. Ensure that medical and pharmacy prior authorization requests and decisions are properly evaluated, documented, and are compliance with all regulatory and accreditation requirements.

Analytical support - Produce and analyze pharmaceutical cost trends and support pharmacy benefit design in collaboration with the Director of Pharmacy and Yale Health Senior Team.

Quality improvement and compliance - Review existing clinical policies and ensure clinical practice guideline changes are reflected. Ensure all pharmacy management programs meet applicable utilization management regulations and accreditation requirements. Ensure that plan formulary is consistent with current standard of quality medical care and medical necessity. Assist in the development and maintenance of quality improvement projects, quality metrics, and quality outcome measurements. Work with internal and external staff to ensure accurate implementation of the formulary in accordance with regulatory and/or contractual requirements. Responsible for ensuring that the Plan's website is current and accurate including prior authorization criteria, formulary, links, explanations for how to file a request for coverage, etc.

Secondary:
Act as a resource for drug information and pharmacy business support for key internal and external stakeholders.
Present strategies to decrease pharmacy and healthcare costs and assist in provider detailing strategies to successfully implement recommendations.
Assist in the creation of Yale Health pharmacy-related member and provider communication materials.
Other activities as necessary to support formulary and utilization management, Yale Health and Yale University initiatives.

Posting Disclaimer

The intent of this job description is to provide a representative summary of the essential functions that will be required of the position and should not be construed as a declaration of specific duties and responsibilities of the particular position. Employees will be assigned specific job-related duties through their hiring departments.

EEO Statement:

University policy is committed to affirmative action under law in employment of women, minority group members, individuals with disabilities, and protected veterans. Additionally, in accordance with Yale's Policy Against Discrimination and Harassment, and as delineated by federal and Connecticut law, Yale does not discriminate in admissions, educational programs, or employment against any individual on account of that individual's sex, sexual orientation, gender identity or expression, race, color, national or ethnic origin, religion, age, disability, status as a special disabled veteran, veteran of the Vietnam era or other covered veteran.

Inquiries concerning Yale's Policy Against Discrimination and Harassment may be referred to the Office of Institutional Equity and Accessibility (OIEA).

W.L. Harkness Hall, 3rd Floor, Room 303
100 Wall Street, New Haven CT 06511
203-432-0849
equity@yale.edu

Required Skill/Ability 3:

Ability to interact within all levels of the organization and with external partners; both as a team member and leader. Demonstrated strong organization and time management skills. Ability to work in a fast-paced environment and to multi-task.

COVID-19 Vaccine Requirement

Thank you for your interest in employment at Yale University. Please also note that the university has a COVID-19 vaccination and booster requirement for all students, staff & faculty which is described in the COVID-19 Vaccine Program. As you search our open positions, you will see that all postings list their on-site addresses which gives more detail on the on-campus work location of the role.
Refer code: 3482868. Yale University - The previous day - 2023-03-28 18:02

Yale University

New Haven, CT
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