Clinical Manager

Profile

Description

The Clinical Pharmacy Lead monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge to develop, and/or implement strategies and programs to mitigate cost trend and improve health outcomes. The Clinical Pharmacy Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

Enclara, is a wholly owned hospice and palliative care pharmacy business acquired by Humana in 2021. Enclara is the nation's largest full-service pharmacy benefits manager (PBM) specifically for the hospice and palliative care sectors. Serving over 450 customers and nearly 100,000 patients nationally, Enclara works closely with hospices to reduce pharmacy costs, improve patient care and support caregivers through: digital innovations, flexible medication access, one-on-one clinical support, and excellent customer service.

The Clinical Account Manager (CAM) is directly responsible for developing and maintaining relationships with the assigned client(s). The Clinical Account Manager is strategic, consultative and proactive. She/he focuses on both business and clinically-based initiatives, and is responsible for client cost management and satisfaction. The CAM is responsible for guiding clients towards cost-effective therapies as well as the efficient use of clinical resources. She/he is accountable for driving clinical initiatives which contribute to the overall success of the organization. The CAM will be responsible for being onsite with an account or branch for quality assessment and process improvement to positively impact overall financial results. The CAM will be the point person for all client related issues and serve as an internal resource to the hospice for overall account success related to medication cost and utilization

Essential Functions:

Include, but not limited to the following:

Account Support

Conduct strategic onsite business reviews with hospice executives and clinical leadership with a focus on key financial and utilization metrics, clinical data, clinical medication initiatives, and collaborative partnership opportunities.

Manage and strengthen client relationships and ensure client satisfaction and service level agreements are met, through routine ongoing contact.

Serve as the Enclara-client main point of contact regarding account and clinical issues and facilitate resolution to identified needs.

Initiate and monitor client-specific initiatives and plans and participate in internal communication updates.

Provide routine client feedback and represent the 'voice of the customer' to internal Enclara teams with the goal of ongoing quality and service improvements.

Collaborate with account management and clinical management leadership teams to ensure seamless client support.

Document all client interaction in Salesforce.

Clinical Support

Identify key factors that may impact overall client success and satisfaction according to Enclara and hospice leadership.

Develop and document a performance improvement plan, in conjunction with hospice leadership, to improve key metrics.

Help define and refine corporate formulary development and perform continuous utilization and analysis on medications.

Review Enclara data sources to proactively monitor medication cost, utilization, and patient data to provide clinically appropriate cost-effective medication utilization analysis and recommendations. Empower individuals within the hospice to utilize Enclara tools to support utilization and medication management

Develop and present educational sessions for nurses and physicians on Medication Use Guidelines, Formulary Management, deprescribing, Determining Related Status, Pain and Symptom Management, etc.

Occasionally attend Quality Assurance/Performance Improvement meetings and support for QAPI initiatives.

Create and manage ongoing plan to manage multi-branch metrics; support onsite at those sites as needed.

Provide education and support educational strategies for client referral sources (e.g. Medical groups, Prescribers).

Collaborate with Hospice Medical Directors on additional and ongoing clinical and educational opportunities.

Regional Education

Attend state meetings as needed in defined territory.

Attend national hospice meetings as needed or upon request.

Qualifications:

Ability to work independently and prioritize work in order to meet client needs.

Strong team orientation, commitment to client service, and desire to succeed.

High-energy with a sense of urgency and attention to detail.

Comfortable working in a fast paced, rapidly changing environment.

Excellent verbal and written communication, presentation, and negotiation skills required.

Willingness to travel as needed to meet client and Enclara business needs and travel to offices/branches, typically up to 60% travel.

Must maintain presence and relationships at the corporate hospice level to facilitate relationship building and awareness of business needs

Must live near major metropolitan airport.

Education and/or Experience:

Doctor of Pharmacy degree preferred.

Strong background in hospice and/or palliative care and account management experience preferred.

Candidates should possess a minimum of four years' experience in one of the following areas:

Hospice, Palliative or Geriatric pharmacotherapy practice

Clinical/Executive account management

PBM industry - either clinical or client facing role.

Proficiency with Microsoft Office suite (Work, Excel, PowerPoint, Outlook) required.

Project and account management skills necessary.

Experience with service recovery and development of strategies around maintenance of customer retention required.

Certificates, Licenses, Registrations

Candidate must maintain a current active pharmacist license and may be required to hold multiple state licenses to meet specific client needs.

Advance certifications such as BCPS, CGP preferred.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com