Identify opportunities and best practices in the development and maintenance of programs supported by Medical Affairs
Drive the regulatory strategy of UM programs and support regulatory compliance activities for Medical Affairs
Provide oversight and clinical review of projects ensuring consistency with best practices and ethical standards
Facilitate cross-functional work teams to ensure accurate representation of clinical content and regulatory statutes
Lead the implementation of key priorities in CASA to improve performance and efficiencies
Manage the maintenance and external requests of Medical Affairs UM Policies and Procedures
Support Clinical Program Review Committee meetings
Perform as Medical Affairs Ambassador across organization by supporting all Heartbeat page maintenance throughout Medical Affairs
Work with the Lead Director of Clinical information, Analytics and Regulatory Compliance to ensure equitable application of UM across medical/surgical and behavioral health therapies
Facilitate initiatives to ensure clinical programs (formulary, UM criteria) comply with MHPAEA, CMS, and DOI regulations
Lead audit readiness and response activities for PBM market conduct exams, Mental Health Parity, CMS audits, and internal regulatory reviews
Drive the completion and compliance of the NQTL Library creation and annual review activities
Support analytics activities and collaborations to measure and communicate the value of clinical programs
Analyze large datasets to identify trends and identify opportunities for clinical program optimization and improvement
Assist in the development of business cases and value models to forecast and track program performance and benefits realization
Represent Medical Affairs in cross-functional forums, key initiatives, projects and planning sessions.
Requirements
PharmD/RPh or equivalent clinical pharmacy degree
Active pharmacist license in good standing
7+ years of experience in regulatory pharmacy, managed care, or PBM operations
3+ years of professional experience in reviewing and evaluating data and trends
Strong understanding of MHPAEA, CMS regulations, and audit processes
Demonstrated leadership, organizational and planning skills
Excellent communication and stakeholder engagement skills
Ability to work in an agile environment to support the needs of Medical Affairs as they arise
Comprehensive understanding of managed care, PBM services and customers.
Benefits
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
Job title
Senior Clinical Pharmacist, Medical Affairs – Clinical Innovation and Regulatory Strategy
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