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Cambia Health Solutions Clinical Pharmacist Consultant in Seattle, Washington

Primary Job PurposeThe Clinical Pharmacist Consultant provides professional and clinical expertise for Pharmacy Services' clients in making clinical decisions based on best practices by applying evidence-based medicine evaluations to determine the best quality medication choices that represent the best value in efficacy, safety and affordability. This includes providing coverage recommendations for medications subject to prior authorization, appeals, retrospective claim reviews, and audits based on applicable medication coverage policies, member benefit contracts, and provider contracts.This role may also assist in planning, developing, and implementing clinical strategies with respect to formulary management, drug utilization management, medication therapy management programs, quality initiatives, gaps in care, peer to peer conversations and drug information and education. Advanced responsibilities may include analyzing health care cost information, development of position papers, medication coverage policies, formulary monographs and class reviews, cross-functional projects, and initiatives related to the provision of pharmacy benefits that impact safety, quality and affordability.General Functions and Outcomes* Responsible for delivering high quality clinical services for Pharmacy Services' clients for Medication Benefit Management.* Responsible for conducting peer clinical reviews. (The medical director has the responsibility to determine that the peer clinical reviewers are qualified to render a clinical opinion for items under review.)* Responsible for peer to peer conversations.* Works independently within framework and guidelines to evaluate intangibles associated with cost-containment and quality improvement of prescription drug charges.* Provide coverage recommendations for medications subject to prior authorization, appeals, retrospective claim reviews, and audits based on applicable medication coverage policies, member benefit contracts, and provider contracts.* Provides clinical decision-making based on best practice in applying evidence-based medicine process in determining medications that have best value for efficacy and safety.* Develops and provides educational materials and correspondences to members to inform them about medication coverage choices, comparative effectiveness, and coverage determinations.* Provides creative thinking and leadership in accomplishing goals of quality improvement and cost-effective prescription drug programs.* Collects, analyzes, interprets, and forecasts health care cost information based on current prescribing patterns based on medication utilization reports.* Develops position papers, medication coverage policies, formulary monographs and class reviews, and formulary coverage recommendations based on critical appraisal of the scientific literature and input from practicing physicians to ensure optimal clinical outcomes at most cost-effective level.* Presents and/or communicates clinical positions on medication analysis in clear, concise manner.* Presents formulary and medication coverage policy considerations to internal and external decision-making bodies such as the Pharmacy and Therapeutics Committee and Medication Policy Group.* Identify, develop, implement and track complex cross-functional programs, projects, and initiatives related to the provision of pharmacy benefits that impact safety, quality and affordability.* Provides professional services and expertise related to clinical pharmacy practice, evidence-based medicine, and drug products to support the care team, care for patients, support consumers, impact population health, and contribute to the development and maintenance of the digital health platform and suite of products.To view the

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