The HEDIS Clinical Pharmacist will assist with quality measures related to medications and disease states. As an example, these measures include completion of medication reconciliation upon discharge from a facility, improving medication compliance/adherence for certain measures, outreaching to patients with poorly controlled diabetes to identify barriers and assist in overcoming barriers and bringing their diabetes into better control, educating patients on importance of taking statin medication for high risk patients. Will utilize clinical expertise and skills to develop the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to improve pharmacy related quality measures. Will promote, assist and collaborate with our providers with clinically appropriate prescribing practices, based on evidence based medicine and national guidelines. Knowledge of pharmacy reimbursement issues and formulary management is imperative to ensure improved health outcomes to our members, while being cost effective. Reviews and analyzes pharmacy reports to track general trends. Will assist the Medical Director and serve as a clinical resource to all members of the company, providers and members.

Education and / or Experience:

• Bilingual (fluent in Spanish and English) is preferred.
• Graduate of an accredited School of Pharmacy with a current and unrestricted California State Pharmacy License (Pharm. D) required
• Knowledge of PBM industry, formulary management, pharmacy claims and managed care principles and practices preferred
• Minimum of 1 year pharmacy experience within a managed care setting preferred
• Ability to establish and maintain positive and effective work relationships with all levels internally and externally.
• Proficient in Microsoft Applications: Outlook, Word, and Excel
• Proficient understanding of common pharmacy electronic databases and the ability to type >40 WPM
• Is accountable, builds trust, collaborates and pursues excellence
• Has great problem solving skills and “thinks out of the box” to provide solutions
• Ability to work in a multi-task, fast moving environment, is flexible and adapts well to change
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

Essential Duties and Responsibilities include the following:

Will be a leader, responsible for supporting and enhancing the HEDIS department, areas of involvement will include, but not limited to, Medication reconciliations for the identified populations, Medication Adherence for identified populations, health education policies and support for at-risk Diabetic members.

Post Discharge Program:

• Reviews all medications and completes reconciliation between patient’s discharge medications and current medications in accordance with HEDIS and health plan technical specifications.
• Ensure accuracy and effective functioning and manage all communication with physicians and patients and assist to resolve all patients within required timeframe

Medication Adherence:

• Core responsibilities will be related to development, implementation and monitoring of medication adherence policies in non-compliant populations
• Types of interventions: side effects, cost, duplicate therapy, inappropriate dosage, medication review

Disease Management:

• Knowledge of chronic disease/conditions and provide treatment goals, to provide disease specific education to beneficiaries and improve beneficiaries participation for Rheumatoid Arthritis, Diabetes, Hypertension, Hyperlipidemia
• Implement appropriate patient education for management of HbA1C in diabetic population
• Will work closely with Project Manager and other staff to assist in the generation and coordination of intervention for medication adherence and medication reconciliation processes.
• Interface with Providers, pharmacists, and specialty pharmacy providers and other stakeholders as needed to achieve departmental initiatives and goals
• Responsible for staying current with clinical literature and guidelines
• Maintains standards set by the department and translates policies and procedures into the daily operation of the role. Responsible for acting as an information resource to patients, physicians, and other healthcare professionals regarding medication therapy and drug related information and literature.
• Responsible for supporting, participating and providing clinical expertise related to Medicare formulary decisions
• Protect and maintain confidentiality and privacy of all member information, including adherence to strict protocols for HIPAA
• Supports the company’s vision, mission, values, goals and policies
• Performs other duties and responsibilities as assigned

The pay range for this position at commencement of employment is expected to be between $120,000 - $130,000 DOE however, base pay offered may vary depending on multiple individualized factors, including market location, job related knowledge, licensure, skills, and experience. The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered. Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.