This position will work with different populations including the Medicare, Commercial, and Medicaid Partners by analyzing each population's medication utilization data to identify and implement opportunities for improved quality and cost savings. Serve as a resource for the UH Quality Care Network/UH Accountable Care Network) clinical healthcare team, working toward the overall goal of effectively managing the health and well-being of a population of attributed patients, with an emphasis on patients with chronic or complex diseases and/or high utilization patterns. Responsible for providing expert advice on the use of medications and on the provision of pharmacy services to physicians and other clinical staff; collaborating with the PBM prescription employee plan; working closely with the Medical Director to advise on protocols and standards of practice related to medication and pharmacy services; contribute to clinical guidelines for specified disease states; serve as a consultant to the clinical team to review discharge medications and assess for appropriate use of medications to treat conditions based on clinical finding, polypharmacy, cost, and the potential for a simplified regimen. Emphasis is placed on managing resources and supporting patient and family autonomy - exercising initiative and independent judgement based upon professional knowledge. Major areas of focus include data analysis and strategic program development to promote clinically appropriate cost-effective prescribing and to improve quality scores.

Essential Functions

• Reviewing medication utilization data to identify and implement opportunities for improved quality and cost savings at the individual and population level.
• Physician outreach and communication.
• Engaging members referred by physicians, payors, team members, or member self-referrals for medication related concerns.
• Presenting in Clinical Case Management review with Nurse Care Coordinators and third-party vendors.
• Collaborate with third-party vendors' Clinical pharmacist on monthly basis.
• Review medications for Transitions of Care and ED discharge.
• Identifying opportunities for value-based insurance design to improve population health and control cost.
• Conducting individual member case management and care coordination focused on medication management and guidance.
• Effectively collaborating with other UH departments and third-party vendors to advance service lines strategic goals.
• Partnering with Nurse Care Coordinators and Social Workers to coordinate member case management.
• Where appropriate, overseeing Pharmacy Residents on selected projects.

Required For All Jobs

• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.