Clinical Pharmacy Manager

Looking for a way to make an impact and help people?Join PacificSource and help our members access quality, affordable care!PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person''s talents and strengths.Position Overview: The Clinical Pharmacy Manager is responsible for oversight and management of all day-to-day aspects of the Clinical Pharmacists, including but not limited to issuance of all pharmacy coverage decisions, development of policies and procedures and coordination of pharmacy benefits for members. Principal responsibility for maintaining compliance with all state and federal legislation. Coordinate formulary design and implementation across all lines of business to ensure cost-effective utilization and promote evidence-based healthcare. In addition, responsibility includes working collaboratively with other department heads, and leadership throughout the organization to deal with all clinical, administrative, financial & regulatory challenges impacting pharmacy services. Serve as a clinical resource person for Health Services staff, internal associates, and external vendors as necessary. The Clinical Pharmacy Manager is also responsible for the success of the pharmacy residency program and supervision of the Clinical Pharmacy Resident.Essential Responsibilities: Assist Director of Medical and Pharmacy Services and support the Pharmacy Team Leads - in providing direction to pharmacy services, including successful development, implementation, and communication of pharmacy services programs targeted at improving quality measures and meeting departmental goals.Primary responsibility for drug authorizations reviews, including specialty pharmacy. Assist Pharmacy Director with the development and maintenance of policies and procedures pertaining to the pharmacy program.Monitor departmental goals, objectives, and project planning as established by Director of Medical and Pharmacy Services.Maintain an active role in meetings and strategic planning process as they pertain to pharmacy services.Oversee the daily operational activities of pharmacy services staff. Provide input to Director of Medical and Pharmacy Services regarding hiring, development, and performance review of pharmacy staff.Ensure that pharmacy services consistently delivers best practice results in a timely manner.Work with Director of Medical and Pharmacy Services to implement process improvements and internal controls to ensure that pharmacy services personnel operate efficiently. Monitor pharmacy-related performance metrics to evaluate the effectiveness of existing programs and identify and resolve department inefficiencies through the use of standard and ad hoc reports.Utilize appropriate data resources to evaluate and improve member and provider satisfaction with the pharmacy services helpdesk.Assist Director of Medical and Pharmacy Services to design and implement solutions to maintain compliance with federal and state regulations.Primary liaison to participating providers and other contracted entities on clinical pharmacy initiatives.Actively participate in discussions and develop clinical presentations for appropriate departments and business process owners.Ensure that pharmacy services personnel are a valuable resource to Marketing & Sales, Billing and Enrollment, Underwriting, Case Management and Provider Relations departments.Provide clinical resources to medical review team and other plan staff as needed.Consult with medical personnel in the community regarding company policies and procedures as they relate to clinical decision making.Assist Director of Medical and Pharmacy Services with drug formulary design and development, implementation and risk management in a manner that will improve quality, control utilization, and contain costs. Assist Director of Medical and Pharmacy Services with Formulary development, prior authorization criteria and benefit structure for all government lines of business.Assist in the design and implementation of innovative pharmacy benefits, including but not limited to Medication Therapy Management, Medication Adherence Improvement Projects, and Oncology Management Strategies.Assist Director of Medical and Pharmacy Services with the development of all internal and external pharmacy-related educational documentation. Ensure that all pharmacy benefits are administered according to plan direction.As directed, assist marketing and sales teams with member and broker education on pharmacy benefits.Oversee development and maintenance of the Managed Care Pharmacy Residency program, including supervision of the Clinical Pharmacy Resident.Perform other duties as assigned.Supporting Responsibilities: Meet department and company performance and attendance expectations.Perform other duties as assigned.SUCCESS PROFILEWork Experience: A minimum of 5 years of clinical experience in the practice of pharmacy including supervisory experience. Prior success in healthcare integration, process development and program implementation is desirable. Additional experience managing complex work processes and knowledge working within the rules and regulations that govern Medicare, Medicaid, Commercial and Exchange Plans is highly preferred. Education, Certificates, Licenses: Bachelor of Science in Pharmacy and Doctor of Pharmacy degree and valid unrestricted state Pharmacy license in good standings.Knowledge: Comprehensive knowledge of Strategic and operational planning. Personnel Administration. Proven ability to plan, organize, schedule, direct, control and monitor project activities. Well-developed interpersonal skills. Continually seek to improve quality of service, care, and processes for internal and external customers. Assure patient confidentiality, privacy, and health records security. Accurately interpret contractual benefits. Provide compassionate and confidential service to members/patients. Support policy and change process, both internal and with providers. Identify and inform Director of Medical and Pharmacy Services of high exposure cases and/or potential reinsurance claims. Accountable for service to internal and external customers. Thorough understanding of national drug database, pharmacy benefit configuration, and medication pricing. Thorough understanding of Evidence Based Medicine and primary literature resources. Ability to critically evaluate medical literature. Proficient Computer Skills in a Windows Operating System Environment, including data recording and petencies Building TrustCustomer FocusFacilitating ChangeDriving for ResultsBuilding PartnershipsLeveraging DiversityDecision MakingBuilding a Successful TeamAligning Performance for SuccessContinuous ImprovementEnvironment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.Our ValuesWe live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:We are committed to doing the right thing.We are one team working toward a common goal.We are each responsible for customer service.We practice open communication at all levels of the company to foster individual, team and company growth.We actively participate in efforts to improve our many communities-internally and externally.We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.We encourage creativity, innovation, and the pursuit of excellence.Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

Created: 2025-10-04