Gateway Health Plan
Job Description :
This job will works in a team oriented environment. The incumbent works with Gateway Health members on a daily basis to improve engagement and subsequent outcomes as an adjunct to health coaching; will develop and implement physician, pharmacy and member educational initiatives that promote Gateway’s formularies, utilization management programs, and case/disease management initiatives; and will participate in cross-functional committees to develop and implement clinical and operational initiatives. The incumbent may also provide consultation into the case and disease management identification process and consult with Gateway medical directors when appropriate.
- Work one-on-one with Gateway members via face-to-face and/or telephonic interactions. Develop care plans for individual members, coordinate member’s care and assist in the discharge planning process.
- Represent the organization to members, providers, and other staff at participating practices.
- Assist in the development and implementation of various programs, including, but not limited to utilization management, disease management and chronic condition management.
- Address gaps in care, medication adherence and perform medication reconciliation.
- Collaborate with Gateway Health and providers to promote appropriate and cost effective use of medications through adherence to formulary and utilization management requirements.
- Support Gateway Health initiatives to reduce emergency department utilization as appropriate.
- Collaborate with providers and other staff to develop and implement physician, pharmacy, and member educational initiatives that promote Gateway’s formularies, utilization management programs, and case/disease management initiatives.
- Participate in cross-functional committees to develop and implement clinical and operational initiatives within the pharmacy department.
- Identify and assist in managing department process improvements to maximize overall efficiencies.
- Other duties as assigned or requested.
- Bachelor of Science in Pharmacy or a Doctor of Pharmacy degree
- 5 – 7 years of post-graduate pharmacy experience
- 1 – 3 years of related, progressive clinical experience in ambulatory care (as part of three year post-graduate pharmacy experience)
- Experience with Medicaid populations
- Post Graduate Year 1 (PGY1) residency with concentration in ambulatory care
LICENSES OR CERTIFICATES
- Board Certified Pharmacotherapy Specialists (BCPS)
- Board Certified Ambulatory Care Pharmacist (BCACP)
- Strong verbal and written communication skills
- Microsoft Office (Outlook, Word, Excel)
- Managed care experience with fundamental understanding of formulary management and utilization management concepts
- Quickly identify and prioritize issues and requests
- Prepare and present presentations to stakeholders
- Appropriately follow up with measurable outcomes
Language Requirement (other than English)
0% – 25%
Physical, Mental Demands and Working Conditions
General Description for Office-Based Positions
Office-Based: An employee in this position works in an office environment. The position frequently requires the employee to communicate well with others both inside and outside the workplace (e.g., in person, via telephone, via email). The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks. The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Does Not Apply
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
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