Aetna Clinical Pharmacist - Managed Care in Houston, Texas
Req ID: 49081BR
POSITION SUMMARY - This is an office based position in Houston, TX
We are building an exciting new clinical and member experience program at Aetna. Aetna Community Care is a member centric, team-delivered, community based care management model that joins members where they are. The Clinical Pharmacist is responsible for leading pharmacy based strategies and supporting the work of the clinical care teams serving high risk commercial and Medicare Advantage members in a new innovative community based care management program. The Clinical Pharmacist, works directly with the CC clinical staff, as part of the multi-disciplinary team, and is responsible for promoting and implementing pharmacy strategies and interventions that support member centered care management along the health continuum to enhance medication knowledge, adherence, safety and access.
Assesses members medication regimens for indication, effectiveness, safety and adherence. Conducts case reviews to identify, resolve and prevent medication-related problems. Partners with Aetna pharmacy to leverage pharmacy benefits and resources i.e. Medication Therapy Management, Specialty Pharmacy, mail order services. Utilizes clinical and analytical skills to positively impact the health of members while helping to reduce health care costs. Participates in member care conferences and contributes to the member plan of care. Collaborates with the medical and program leadership in developing medication management protocols and education for clinical staff. Supports the health plans NCQA, HEDIS and CMS STARS measures. Participates in the multi-disciplinary team, providing expert consultations to optimize member benefits and access to medications. Confers with prescribers to improve member medication regimens as appropriate. Serves as a pharmacy subject matter expert and drug information resource for clinical staff, providers, program teams and members. Promotes effective communications between customers and business partners. When appropriate, conducts at-home assessments and intervention sessions with highest risk member population. Maintains a comprehensive working knowledge of community resources, payer requirements and network services for target population to maximize benefit to member overall wellbeing. Adheres to care management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. Other responsibilities as assigned.
Current unrestricted state license required. 3-5 years clinical pharmacy experience required (Retail pharmacy experience is not included in the required number of years of experience) Commercial Managed care/managed pharmacy experience required Managed Medicare pharmacy experience required. Experience in managing long-term, medication care plans is required. Pharmacy administrative experience preferred. Understanding HEDIS,Stars, and other quality programs and processes is preferred. Knowledge of clinical program components, formulary designs, and prescription benefit trends. Understanding of medical and pharmacy terminology. Local travel required Bilingual desired The highest level of education desired for candidates in this position is a Doctor of Pharmacy.
The highest level of education desired for candidates in this position is a Doctor of Pharmacy.
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Job Function: Health Care