Pharmacy Operations Specialist IV, Clinical Utilization & Intelligence

Job Summary:

In addition to the responsibilities listed below, this position is also responsible for leveraging a comprehensive understanding of the drugs coming into the market and informing the organization which drugs to use; planning and identifying the proper documentation for pharmacists to aid in the decision-making of drug administration; presenting in the Pharmacist and Therapy committee; forecasting trends to identify incoming drugs within the next five years; providing recommendations for pricing, usage, budgeting, and display of new drugs; partnering alongside the utilization team to identify if the drugs are equally efficacious and safe; reviewing recommendation from others and their review of additional research of niche drugs (i.e., limited benefit coverage and FDA coverage) to review recommendations to physicians, promoting novel drugs to gain approval of niche drug(s) to support the physician(s) usage of the drug(s); developing and reviewing training materials for the PGY2 Residency Program and providing guidance to residents; partnering with physicians to develop guidelines to support patient care and recommendations on best practices; and reviewing the creation of policies and educating physicians on how best to use gene drug interactions; for preparing and documenting insights on how drug(s) are currently being used, what areas are using the drug(s), and pulling from additional data sources; promoting affordability within KP, ensuring drugs are high quality, safe, work efficiently and cost-effective; promoting the rollout of new drug(s), ensuring proper usage and successful implementation across KP; leading the packaging of the clinical evidence summaries from the data to promote the drug(s); guiding the creation of promotional content (e.g., messaging in KP Health Connect, send electronic messaging to the physicians) to introduce new drugs; ensuring the integration of new drugs once physicians review and approve them, initiating the process of moving patients to the new cost-effective drug; and identifying and addressing areas to reduce cost through internal and external partnerships.

Essential Responsibilities:

• Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional/external stakeholders and customers. Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations. Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes. Facilitates team collaboration to support a business outcome.
• Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions; encourages team members to adapt to and follow all procedures and policies. Collaborates cross-functionally and/or externally to achieve effective business decisions; provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Supports the development of work plans to meet business priorities and deadlines; identifies resources to accomplish priorities and deadlines. Identifies, speaks up, and capitalizes on improvement opportunities across teams; uses influence to guide others and engages stakeholders to achieve appropriate solutions.
• Applies strategies and concepts to independently support pharmacy and healthcare professionals by: independently leveraging systems and implementing programs and tools related to analytics and informatics to track prescription use data and support relevant patient-facing teams; collaborating with and co-leading meetings and relevant committees to support front-line operations; and exercising a patient focus throughout ones technical expertise and activities and identifying patient related issues, challenges, possible improvements and taking action to ensure the downstream patient impacts are being followed up on.
• Supports various functions within operations and may support operations in a specific area or set of pharmacies by: collaborating with interdisciplinary teams to implement pharmacotherapy safety practices and initiatives; implementing pharmacy operations initiatives and programs that directly support the day to day functioning of a specified set of pharmacies or locations and orchestrates across relevant groups on the rollout, staffing, education, etc. requirements; and maintaining various operational needs (e.g., workflow management, policy management, systems improvement, etc.), ensuring policy compliance, and identifying possible process or system improvements.
• Contributes to service, affordability, people, quality of care, and regulatory pharmacy goals by: leading efforts to create, design, and help implement strategic plan to support improvements to service, quality, people, affordability, and regulatory initiatives; evaluating data trends from and may being aiding in creation of tools and dashboards to enable implementation of new programs and initiatives; reviewing and mentoring others to conduct sweeps of new laws and rules from regulatory agencies and ensures application into operations (e.g., FAQs to markets); building and socializing new tools to ensure awareness and use; evaluating accuracy of inputs into and may be building accountability dashboard to ensure rules are followed; and aligns own operations goals to and assists junior colleagues to adhere to key affordability metrics.
• Serves as a subject matter expert for quality improvement processes and regulations within assigned area by: maintaining awareness of current internal policies and relevant external laws, regulations, and standards and serves as a source of expertise within certain defined areas; independently coordinating committees and projects that provide input and guidance on various improvement initiatives; developing, conducting, coordinating, and identifying quality improvements related to medication safety for assigned clinical area; researching and reporting related material; and anticipating issues, weighing practical considerations in addressing issues and seeking input from engagement manager/sponsor to resolve; leveraging knowledge of a wide array of drugs and their uses and how they impact clinical practices; guiding members, patients and/or healthcare providers to understand appropriate use and application of prescribed medication and providing drug information to relevant healthcare providers; applying advanced strategy to ensure achievement of member financial and therapeutic objectives; and analyzing, tracking, and reporting detailed member data to help assess plan outcomes.