Job Description

Let’s do great things, together!

About Moda
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Position Summary
We are currently seeking a skilled and dedicated pharmacist to join our Clinical Pharmacy team as a Clinical Pharmacist. This role is well suited for a detail-oriented individual with significant clinical expertise and a desire to contribute to the mission of ensuring access to high quality and cost-effectiveness medications for the members and plan sponsors we serve. This role is primarily responsible for formulary management and developing utilization management strategies through data-driven decision-making and evidence-based medicine. This role is also responsible for supporting the prior authorization workflow by performing coverage determinations. Our organization has business that spans multiple states and lines, from commercial to health care exchange, Medicare and Managed Medicaid and we offer and manage both medical and pharmacy benefits. The Clinical Pharmacist will collaborate with internal teams, providers, and external vendors to optimize medication use and contribute to the overall success of our pharmacy programs. This position will report to the Supervisor of Clinical Pharmacy.  The ideal candidate resides near or within commuting distance of our Portland, Oregon office to support a hybrid work arrangement, however, remote status will also be considered. 

Pay Range
$111,640.18 - $142,337.61 annually (depending on experience)
*Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Please fill out an application on our company page, linked below, to be considered for this position.

Benefits :

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Required Skills, Experience & Education:

• Current active and unrestricted Oregon Registered Pharmacist license, or eligible for Oregon licensure which is to be obtained within 60 days of hire date 
• Effective communication and interpersonal skills to interact with healthcare providers, internal teams, and external stakeholders 
• Proficient with Microsoft Word, Excel, Outlook, and PowerPoint
• Strong written and verbal communication skills 
• Commitment to service, organizational values, and professionalism through appropriate conduct and demeanor always 
• Works well under pressure with frequent interruptions and shifting priorities 
• Strong critical thinking skills and ability to work independently
• Follow the company HR policies, Code of Conduct, and all department policies and procedures including protecting confidential company, employee, and customer information 

Preferred Skills, Experience & Education: :

• Doctor of Pharmacy degree (Pharm.D.) 
• Two to three years of managed care experience or training from an accredited managed care residency program 
• Experience in clinical therapeutics for specialty drugs  
• Advanced competency in literature evaluation 
• Project management skills and the ability to plan and execute projects pertaining to formulary design and clinical programs 

 

Primary Functions :

• Develop and implement clinical utilization criteria for new market entries and market updates utilizing evidence-based medicine principles 
• Prepare and present clinical materials for Pharmacy & Therapeutics (P&T) Committee meetings, including but not limited to class reviews, monographs/new product reviews, and medication policies  
• Conduct drug utilization reviews and data analysis to identify opportunities for formulary improvements and cost-effective medication strategies 
• Provide clinical support services including but not limited to benefit design, formulary analysis, drug information, utilization management, and client/provider support 
• Perform coverage determination for all lines of business (i.e., commercial, exchange, government) for pharmacy and medical (physician-administered or home infusion) medications 
• Participate in the appeals and grievances process by providing clinical expertise and reviewing medication-related appeals and complaints 
• Provide rotating weekend/holiday pharmacist coverage for medication requests and provide internal pharmacist support to the pharmacy team, appeals unit, and customer services department 
• Collaborate across all operational units to deliver the highest level of care in regards to formulary management strategies 
• Deliver clear, comprehensive, and timely responses to requests for drug information to members, clients, providers, and internal staff 
• Review, update, and maintain policies and procedures related to clinical pharmacy services.
• Lead or contribute to special projects and other related duties as assigned by the Director of Pharmacy and departmental leadership 

Working Conditions & Contact with Others

• Extensive close keyboard and computer work, constant sitting, and occasional phone work. Must be able to navigate multiple screens. Provide rotating weekend/holiday pharmacist coverage. Occasionally work in excess of standard work week to meet business need. The ideal candidate resides near or within commuting distance of our Portland, Oregon office to support a hybrid work arrangement, however, remote status will also be considered.
• Interdepartmental work within the company including Customer Service, Healthcare Services, Legal, Marketing, Medicare/Medicaid, Membership Accounting, Quality Management, Policy, Regulatory & Compliance, and Sales & Account Services. External work outside of the company with Pharmacy Benefit Manager (PBM), medical management organizations, CMS, pharmaceutical manufacturers, consultants/producers, auditors, business partners/vendors, clients, prospective clients, physicians and other prescribing providers, and pharmacists.

 

Together, we can be more. We can be better.

 
Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training. 

For more information regarding accommodations, please direct your questions to Kristy Nehler & Danielle Baker via our humanresources@modahealth.com email.

Job Tags

Holiday work, Full time, Temporary work, Remote job, Shift work,

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