Job Details

Senior Clinical Pharmacy Strategist

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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

The Senior Clinical Pharmacy Strategist is responsible for helping improve, develop, and implement initiatives necessary to execute on PacificSource Clinical Pharmacy strategies and management priorities. This role supports the Vice President of Pharmacy Services in executing enterprise cost of care strategies, strategic roadmaps, and quality initiatives that directly impact STARS rating, HEDIS measures, and overall quality performance. This role is pivotal in supporting the alignment of pharmacy services with enterprise-wise goals for cost containment, regulatory compliance, and member outcomes. Additional duties include analyzing and reporting on performance and operational capabilities and streamlining processes and systems within pharmacy services. Key responsibilities encompass cross-departmental collaboration in analyzing, designing and implementing infrastructures for programs that elevate clinical quality, optimize medication use, and support CMS STAR ratings and PQA pharmacy performance measures.

Essential Responsibilities:

• Track, analyze, and interpret quality metrics to identify gaps in care, improve outcomes and ascertain opportunities for improvement.
• Partner cross-functionally with Care Management, Utilization Management, Provider Network, and Medical Directors to design and deploy integrated quality performance programs to enhance member outcomes and provider engagement.
• Lead the creation and execution of clinical program strategies that align with organizational goals and advance STARS and HEDIS performance metrics through targeted pharmacy initiatives.
• Design dashboards and reporting tools to monitor quality metrics and pharmacy impact on STARS.
• Develop strategic plans with defined goals, objectives, and success metrics; present program proposals and performance outcomes to senior leadership and quality committees for endorsement and support.
• Ensure programs comply with regulatory requirements and quality standards.
• Monitor and evaluate program performance, making data-driven adjustments as needed.
• Facilitate workgroups and committees to gather input and drive program development.
• Maintain a detailed understanding of all shared data elements (drug data including GPI, NDC, HCPC, and ICD-10 coding) and the systems necessary to support actionable interventions.
• Conduct outcome analyses to evaluate quality programs, initiatives and interventions utilizing multiple data sources to determine the effectiveness of activities and make recommendations to improve outcomes for CMS Stars, NCQA, QIM (HEDIS, CAHPS).
• Provide structured project management for clinical initiatives, ensuring timely and within-scope completion.
• Develop and manage within project timelines, budgets, and resources.
• Coordinate cross-functional teams to develop and deploy annual improvement plans with performance metrics, monitor risk, deploy mitigation strategies and elevate to joint operating committees as needed.
• Lead quality improvement initiatives to enhance patient care and safety.

Supporting Responsibilities:

• Work with Clinical Pharmacy leadership to improve processes, systems, reporting, and services provided by the department.
• Support Clinical Pharmacy leadership by delivering actionable data analytics that inform enterprise cost-of-care strategies and monitor clinical team performance metrics, as assigned.
• Assists Leadership in the planning, development, and implementation of the clinical and operational processes for MTM Services within Medicare Part D products.
• Represent Pharmacy Services Department, both internally and externally, as requested.
• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

Success Profile

Work Experience: Minimum of 5 years of clinical program management experience or similar role with experience in healthcare integration, process development, or enterprise program implementation. Additional experience managing complex work processes is highly preferred.

Education, Certificates, Licenses: Bachelor's degree required. Preferred degree in public health, mathematics, statistics, data or computer science, or similar research related field. Preference for post-graduate degree in any preferred field

Knowledge: Demonstrated leadership skills and ability to multitask. Knowledge of national and state quality measures such as CMS Stars, NCQA, HEDIS, preferred. Critical thinker and problem solver. Ability to adapt and prioritize within a fast-paced environment. High attention to detail. Experience with medical billing, claims processing systems, data analytics, and health care information strongly preferred. Must have strong analytical and problem-solving skills. Knowledge of healthcare regulations, clinical and managed care performance metrics and quality improvement methodologies. Ability to assess pharmaceutical technologies and new approaches to delivering pharmacy services. Strong communication skills, ability to work independently and within groups with minimal supervision.

Competencies:

• Adaptability
• Building Customer Loyalty
• Building Strategic Work Relationships
• Building Trust
• Continuous Improvement
• Contributing to Team Success
• Planning and Organizing
• Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel less than 5%.

Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Our Values:

• 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.