Pharmacist Care Navigator - 32 hours/week - Evernorth - California - The Cigna Group
Bloomfield, CT
About the Job
Pharmacy Care Navigator - Clinical Pharmacist Part time 32 hour/week – California (remote)
_Pharmacy Care Navigators are healthcare professionals, who serve as customer advocates to coordinate, support, and guide care for our customers and families. The Pharmacy Care Navigator is responsible for working with other members of the Pharmacy Care Team to ensure Evernorth is delivering on its promise to help members navigate and maximize their benefit, help improve clinical outcomes and optimize drug therapy._
Day in the Life Responsibilities:
+ Reviews pharmacy data to extract market and member trends to develop targeted interventions.
+ Navigation of multiple analytical programs and clinical systems that will provide data to improve clinical and financial outcomes and support trend management.
+ Collaborates with case management, behavioral clinician, Medical Director, and member's provider to provide whole-person health support.
+ Participate and collaborate in an innovative, targeted program that drives improved outcomes for a high-needs population.
+ Perform targeted evaluations of available customer health records and using evidence-based medicine, educate and engage customers in successfully managing their drug regimen and chronic conditions.
+ Establish credibility as a trusted partner and advisor to our provider partners, including interventions and recommendations to address quality measures and other clinical pharmacy concerns based on evidence-based protocols and guidelines.
+ Assists in driving customer to cost effective treatments, including brand-to-generic medication utilization.
+ Close gaps and barriers to medication adherence and assisting customers with compliance of 90-day refill rates versus 30-day, driving utilization of home delivery through pharmacy benefits manager (PBM).
+ Provides clinical consultation and drug information to matrix partners and navigator team:
+ General medication questions
+ Medication regimen reviews/consultations
+ Medication reviews for polypharmacy
+ Safety concerns
+ Medication adherence
+ Gaps in care
+ Adherence to evidence-based treatment guidelines
+ Drug information (side effects, interactions, etc.)
+ Interfaces with the customer, family members/caregivers, providers, and internal partners to coordinate the needs of the customer through telephonic, email, text, and chat interactions.
+ Participates in rapid-cycle improvement processes with daily work/focus shifting to meet member trends.
+ Tracks daily activities to trend volume and outcomes.
+ Toggles between multiple systems and applications.
+ Prioritizes work to meet commitments aligned with organizational goals.
+ Understands and adheres to organizational performance measures to deliver on key results.
+ Completes training within the communicated time limit as required per role.
+ Demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
+ Proactive, nimble, and problem solving to resolve immediate customer needs.
+ Assesses for, and facilitates resources, to aid/assist with Social Determinants of Health needs.
Minimum requirements:
+ Active, registered Pharmacist/PharmD in good standing in California, with the ability to obtain licensure in additional states as needed
+ Minimum of at least 2 or more years of clinical pharmacy experience.
+ Demonstrates effective organizational skills and flexibility to meet the business needs.
+ Excellent communication skills including telephonic (verbal) and digital (messaging, emails).
+ Strong computer skills in Microsoft word, Excel, Outlook, and ability to perform thorough internet research, clinical reference materials, and evidence-based medical literature.
Preferred requirements:
+ Successful completion of an ASHP accredited pharmacy residency preferred
+ Board of Pharmacy Specialties (BPS) Certification preferred
+ Knowledgeable of specialty pharmaceuticals for: Inflammatory Conditions, Oncology, and Skin Conditions
+ Highly evolved clinical pharmacy skills and/or clinical knowledge and application of chronic condition/population health management.
+ Direct Managed Care Health Plan and/or Pharmacy Benefit Manager (PBM) experience
+ Strong understanding of health disparities/SDOH and their impact on overall health outcomes.
+ Previous experience with pharmacy quality HEDIS measures.
+ Previous experience in Medicaid and/or Marketplace/Accountable Care plans.
+ Previous experience with drug utilization trend/performance reporting and pharmacy benefit design and implementation
+ Adapts approach in real time to match the agile demands of multiple initiatives.
+ Ability to manage multiple, complex situations in a challenging environment by collaborating with clinical and other business partners.
+ Ability to recognize, address and resolve conflicts in a professional, collaborative manner.
+ Demonstrates sensitivity to culturally diverse participants, situations and customers.
This is a remote role but the Pharmacist must reside in California and possess a CA license.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 111,900 - 186,500 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .
About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._
_If you require reasonable accommodation in completing the online application process, please email:_ _SeeYourself@cigna.com_ _for support. Do not email_ _SeeYourself@cigna.com_ _for an update on your application or to provide your resume as you will not receive a response._
_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._
_Pharmacy Care Navigators are healthcare professionals, who serve as customer advocates to coordinate, support, and guide care for our customers and families. The Pharmacy Care Navigator is responsible for working with other members of the Pharmacy Care Team to ensure Evernorth is delivering on its promise to help members navigate and maximize their benefit, help improve clinical outcomes and optimize drug therapy._
Day in the Life Responsibilities:
+ Reviews pharmacy data to extract market and member trends to develop targeted interventions.
+ Navigation of multiple analytical programs and clinical systems that will provide data to improve clinical and financial outcomes and support trend management.
+ Collaborates with case management, behavioral clinician, Medical Director, and member's provider to provide whole-person health support.
+ Participate and collaborate in an innovative, targeted program that drives improved outcomes for a high-needs population.
+ Perform targeted evaluations of available customer health records and using evidence-based medicine, educate and engage customers in successfully managing their drug regimen and chronic conditions.
+ Establish credibility as a trusted partner and advisor to our provider partners, including interventions and recommendations to address quality measures and other clinical pharmacy concerns based on evidence-based protocols and guidelines.
+ Assists in driving customer to cost effective treatments, including brand-to-generic medication utilization.
+ Close gaps and barriers to medication adherence and assisting customers with compliance of 90-day refill rates versus 30-day, driving utilization of home delivery through pharmacy benefits manager (PBM).
+ Provides clinical consultation and drug information to matrix partners and navigator team:
+ General medication questions
+ Medication regimen reviews/consultations
+ Medication reviews for polypharmacy
+ Safety concerns
+ Medication adherence
+ Gaps in care
+ Adherence to evidence-based treatment guidelines
+ Drug information (side effects, interactions, etc.)
+ Interfaces with the customer, family members/caregivers, providers, and internal partners to coordinate the needs of the customer through telephonic, email, text, and chat interactions.
+ Participates in rapid-cycle improvement processes with daily work/focus shifting to meet member trends.
+ Tracks daily activities to trend volume and outcomes.
+ Toggles between multiple systems and applications.
+ Prioritizes work to meet commitments aligned with organizational goals.
+ Understands and adheres to organizational performance measures to deliver on key results.
+ Completes training within the communicated time limit as required per role.
+ Demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
+ Proactive, nimble, and problem solving to resolve immediate customer needs.
+ Assesses for, and facilitates resources, to aid/assist with Social Determinants of Health needs.
Minimum requirements:
+ Active, registered Pharmacist/PharmD in good standing in California, with the ability to obtain licensure in additional states as needed
+ Minimum of at least 2 or more years of clinical pharmacy experience.
+ Demonstrates effective organizational skills and flexibility to meet the business needs.
+ Excellent communication skills including telephonic (verbal) and digital (messaging, emails).
+ Strong computer skills in Microsoft word, Excel, Outlook, and ability to perform thorough internet research, clinical reference materials, and evidence-based medical literature.
Preferred requirements:
+ Successful completion of an ASHP accredited pharmacy residency preferred
+ Board of Pharmacy Specialties (BPS) Certification preferred
+ Knowledgeable of specialty pharmaceuticals for: Inflammatory Conditions, Oncology, and Skin Conditions
+ Highly evolved clinical pharmacy skills and/or clinical knowledge and application of chronic condition/population health management.
+ Direct Managed Care Health Plan and/or Pharmacy Benefit Manager (PBM) experience
+ Strong understanding of health disparities/SDOH and their impact on overall health outcomes.
+ Previous experience with pharmacy quality HEDIS measures.
+ Previous experience in Medicaid and/or Marketplace/Accountable Care plans.
+ Previous experience with drug utilization trend/performance reporting and pharmacy benefit design and implementation
+ Adapts approach in real time to match the agile demands of multiple initiatives.
+ Ability to manage multiple, complex situations in a challenging environment by collaborating with clinical and other business partners.
+ Ability to recognize, address and resolve conflicts in a professional, collaborative manner.
+ Demonstrates sensitivity to culturally diverse participants, situations and customers.
This is a remote role but the Pharmacist must reside in California and possess a CA license.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 111,900 - 186,500 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .
About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._
_If you require reasonable accommodation in completing the online application process, please email:_ _SeeYourself@cigna.com_ _for support. Do not email_ _SeeYourself@cigna.com_ _for an update on your application or to provide your resume as you will not receive a response._
_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._
Source : The Cigna Group
