Pharmacy Clinical Consultant
Cambia Health

Job Info

---

Pharmacy Clinical Consultant Work from home within Oregon, Washington, Idaho or Utah

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia's dedicated team of Pharmacy Clinical Consultants are living our mission to make health care easier and lives better. As a member of the Health Service Organization on the High Cost team, our Pharmacy Clinical Consultant is a pivotal position responsible for designing, implementing, assessing, and maintaining clinical programs and strategies that drive cost containment and clinical quality enhancements related to pharmacy services. This role involves close collaboration with internal stakeholders to ensure seamless alignment with care management, provider engagement, and member engagement strategies - all in service of creating a person-focused health care experience.

Are you a Pharmacist passionate about driving clinical excellence and cost containment in pharmacy services? Are you a healthcare professional looking for a new challenge? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

• Bachelor's degree in a health related field
  
• 4 years of experience in ambulatory care/hospital/pharmacy benefit management
  
• Pharm.D. degree and experience in pharmacy benefit management and clinical program development is preferred
  
• Must be an active and unrestricted licensed pharmacist in state of practice
  

Skills and Attributes:

• Possesses in-depth knowledge of the pharmacy benefit management industry, including benefit design, pharmacy products and services, and competitive offerings, as well as client needs.
  
• Demonstrates strong understanding of healthcare economics and financing, industry dynamics, and pharmacy/provider service reimbursement of medications.
  
• Exhibits strong clinical knowledge and understanding of evidence-based medicine principles, with the ability to apply them to formulary design, medication coverage policies, and other medication management solutions.
  
• Proven ability to interpret complex clinical information, claims data, and regulatory requirements to develop practical and creative product development solutions.
  
• Demonstrates leadership and interpersonal skills, with the ability to effectively manage projects and vendor relationships.
  
• Possesses excellent verbal and written communication skills, strong business analytical skills, and project management and coordination abilities.
  
• Proven success in managing professional business relationships in the healthcare delivery industry, including managed care systems, medical groups, and hospitals.
  
• Familiarity with health plan and benefit design structures, Medicare/CMS regulations, and pharmaceutical products, including orals, injectables, infusion products, and chemotherapy.
  
• Knowledge of healthcare coding and payment systems, such as ICD-10, CPT, HCPCS, and NDC.
  
• Understanding of state and federal laws and rules regarding pharmacy practice and healthcare industry regulations, including DOLI, PPACA, and HIPAA.
  
• Familiarity with compliance-related activities, legislative and regulatory activities, health insurance operations, and legal research is desirable.
  

What You Will Do At Cambia:

• Lead the identification of clinical areas for product development and execute clinical programs to meet member needs, including pilots with strategic partners.
  
• Stay abreast of industry trends and market differentiating clinical strategies to maintain competitive knowledge.
  
• Analyze utilization trends and quality outcomes, providing creative solutions to support cost containment, quality improvement, and regulatory compliance.
  
• Evaluate and select vendor clinical offerings that align with Regence's clinical and business goals, and negotiate, monitor, and manage vendor performance.
  
• Contribute to pharmacy clinical strategies, formulary development, policy development, benefit design, and utilization management initiatives.
  
• Regularly assess and refine clinical product offerings to maintain a competitive portfolio with strong ROI, and design/improve clinical and operational processes to support exceptional member experiences and operational efficiency.
  
• Provide consultative expertise to strategic partners, plan leadership, purchasers, and other stakeholders, and mentor/coach pharmacy students and residents as needed.
  
• Provide consultative expertise and coaching to internal RN and SW case managers, attend clinical rounds when appropriate to support care management process and initiatives.
  

#LI-Remote

The expected hiring range for a Pharmacy Clinical Consultant is $119,900 - $162,200 an hour depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 15%. The current full salary range for this role is $112,000 - $184,000.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:

• Work alongside diverse teams building cutting-edge solutions to transform health care.
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
• Grow your career with a company committed to helping you succeed.
• Give back to your community by participating in Cambia-supported outreach programs.
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

Learn more about our benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.

---