The Care Coordination Pharmacist will be an integral member of the SFHP Care Management Team. They will provide both direct medication-related counseling to selected/targeted members as well as medication-related consultative expertise to other Health Services clinical staff.
WHAT YOU WILL DO
- Be available to Health Services staff for ad hoc information queries related to the medications being taken by members for staff is providing either direct care coordination or utilization review.
- On an ad hoc basis help coordinate medication-related discharge planning if necessary discharge medications involve prior authorization through SFHP; work to ensure that such requests are reviewed in a timely manner so as not to delay discharge or render a member unable to access necessary medication post-discharge.
- On selected members participate in the discharge planning/post-discharge repatriation process. This may involve member education about new medications taken post-hospital discharge or conducting a formal medication reconciliation assessment and communicating findings/recommendations.
- Provide medication therapy management (MTM) assessment and recommendations to selected member actively engaged in either SFHP’s disease management programs (asthma, diabetes), CareSupport program, or complex medical case management program.
- Provide MTM services to members identified through as yet undeveloped administrative identification queries based upon the number and complex of chronic medications taken.
- Upon request be available to back fill clinical pharmacy staff (vacations, unplanned absences) in reviewing pharmacy prior authorization requests for medical necessity, using best practices and quality standards and meeting turn-around times as defined in the departmental metrics.
- Represent the pharmacy perspective in monthly Grand Rounds case discussions.
- Brings significant issues to the attention of the Director of Pharmacy with recommendations for solutions.
WHAT YOU WILL BRING
- Registered Pharmacist (Doctor of Pharmacy Preferred) with a California State license.
- Experience with Medication Therapy Management program development or delivery.
- Experience in an HMO or experience in managed care setting.
- Knowledge of, and experience with, state and federal insurance programs.
- Extensive knowledge of pharmacy workflow from prescription to claims submission and authorization request processing.
- Ability to work effectively, independently, and as part of a team.
- Ability to work with Essette team in building MTM assessment and document member interactions in Essette.
- Ability to communicate medication related information and recommendations effectively with other SFHP staff (clinical and non-clinical), providers and vulnerable SFHP members.
- Familiar with health care, managed care terminology, or Medi-Cal preferred.
- Strong organization, time management and project management skills and multi-tasking abilities.
- Advanced analytical skills and problem solving skills with the ability to formulate and communicate recommendations for improvement.
- Knowledge and application of English grammar including composition, editing and proofreading skills.
- Knowledge of the San Francisco health community, including public and private entities and their role in the provision of health care to San Francisco residents.
- Familiarity with appropriate local, state, and federal regulations.
Established in 1997, San Francisco Health Plan (SFHP) is a an award winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco county. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 145,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. SFHP was designed by and for the residents it serves, and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities.
San Francisco Health Plan is an Equal Opportunity Employer (EOE M/F/D/V).
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.