Clinical Pharmacist Consultant

3-5 years

$119,100 to $142,200 per year

Remote, USA

10 Dec. 6, 2024

Job Description

Job Type: Full Time Education: PharmD Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

Position: Clinical Pharmacist Consultant
Company: Cambia Health Solutions
Location: Remote (Eligible to work from Oregon, Washington, Idaho, or Utah)
Compensation: $119,900 to $142,200 per year (estimated pay, based on skills and experience)
Employment Type: Full-Time
Benefits Offered: Medical, Dental, Vision, Paid Time Off (PTO), Retirement

About Cambia Health Solutions

Cambia Health Solutions is a purpose-driven organization with a mission to create a person-focused and economically sustainable healthcare system. With a history spanning over 100 years, Cambia fosters a culture of trust, innovation, and collaboration. The company provides cutting-edge solutions that aim to transform healthcare while prioritizing the well-being of its employees and the communities it serves.

Role Overview

The Clinical Pharmacist Consultant is a key member of the Pharmacy Services team. In this role, you will provide clinical expertise to support evidence-based medication management strategies. Responsibilities include evaluating prior authorization requests, appeals, and claim reviews; advising on medication efficacy, safety, and cost; and contributing to formulary management and clinical program development. This position allows you to leverage your pharmacy expertise to drive cost-effective, high-quality healthcare delivery.

Key Responsibilities

Clinical Guidance and Decision-Making

Evaluate prior authorization requests, appeals, and retrospective claims, ensuring evidence-based recommendations.
Optimize medication choices for efficacy, safety, and affordability using evidence-based medicine practices.
Develop and provide educational materials for providers regarding medication coverage, effectiveness, and determinations.

Strategic and Operational Contributions

Analyze healthcare cost trends and identify opportunities for quality improvement in pharmacy benefits.
Collaborate on cross-functional projects related to pharmacy benefit safety, quality, and affordability.
Support the execution of clinical programs and strategic initiatives, including formulary and medication therapy management programs.

Team Collaboration and Support

Work with case management teams to provide member support, clinical reviews, and education on medication management trends.
Present clear and concise clinical analyses and recommendations to stakeholders.

Qualifications

Education and Licensure

Bachelor’s degree or Doctor of Pharmacy (PharmD).
Active, unrestricted pharmacist license in the state of practice.

Experience

3-5 years in a clinical acute care/hospital setting.
Pharmacy residency or advanced degree in a health-related field is preferred.

Skills and Knowledge

Strong clinical pharmacy expertise with a focus on evidence-based practices.
Familiarity with healthcare economics, reimbursement models, and regulatory requirements.
Proficiency in healthcare industry regulations (e.g., HIPAA, Medicare/CMS).
Exceptional communication and analytical skills, with the ability to collaborate across teams.

Why Join Cambia Health Solutions?

Compensation and Benefits

Competitive salary and performance-based bonus opportunities (15% bonus target).
Market-leading 401(k) with a significant company match and potential discretionary contributions.
Generous paid time off (varies by role and tenure) and 10 company-paid holidays.
Comprehensive medical, dental, and vision plans, including mental health benefits.
Paid parental leave (up to 12 weeks).
Award-winning wellness programs.

Work Environment

Remote work flexibility with support for a healthy work-life balance.
Opportunities for professional growth and meaningful collaboration with diverse teams.

Commitment to Diversity and Inclusion

Cambia Health Solutions is an Equal Opportunity Employer dedicated to diversity, inclusion, and a tobacco-free workplace. The organization provides accommodations during the hiring process for applicants with disabilities.

Join Cambia Health Solutions to contribute to innovative, person-focused healthcare while enjoying a supportive, purpose-driven work environment.

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