Under the direction of the Director, Pharmacy Services, the Pharmacy Medicaid Program Manager is responsible for assisting pharmacies, physician offices, and internal stake holders in the timely and effective provision of pharmaceutical products and services to County Care Health Plan members. The Pharmacy Medicaid Program Manager serves as patient advocate when giving direction in the planning and implementation of pharmaceutical care by considering the patient's disease condition, age background, need for understating and participation in drug therapy in a fiscally responsible manner. The Pharmacy Medicaid Program Manager is responsible for consultation of safe, effective, and cost-effective use of drugs through the application of specialized knowledge, skills and professional judgement. Additional responsibilities include, but are not limited to, evaluation of drug utilization information, provision of information on formulary programs, providing education on clinical programs, and serving as a drug information resource.
This position is exempt from Career Service under the CCH Personnel Rules.
Assesses pharmacy products and services for health plan members to ensure optimum outcomes, cost effectiveness, and compliance with all state and federal regulations and guidelines
Participates in the development/ administration of programs designed to enhance the utilization of targeted drugs and the identification of cost saving pharmacy practices
Develop/ maintain pharmacy programs i.e., Medication Therapy Management, Adherence initiatives, generic conversion initiatives, etc. Acts as a resource to others
Work closely with Interdisciplinary Care Team to identify barriers and improve compliance with prescribed chronic disease medications
Participate in development of educational lectures and materials for clinical staff.
Review Medicaid and Medicare prior authorization requests and make determinations for drug products according to member benefits and coverage criteria
Serves as a liaison between health plan and PBM associates on issues of policies and procedures, clinical criteria justification, define roles and responsibilities to prior authorization/coverage determination decisions and/or during inbound or outbound phone calls
Consults with and as necessary refers cases to Director of Pharmacy
Provide PBM oversight and ensure health plan/PBM handles prior authorization/coverage determination requests within all federal and state regulatory compliance time frames
Project management and process improvement experience, ability to take initiative, and to think globally based on business goals and objectives.
Knowledge of concepts of formulary and Pharmacy & Therapeutics Committee and clinical programs (e.g., utilization management) and PBM
Bachelor of Science in Pharmacy or PharmD from a college of pharmacy accredited by the American College of Clinical Pharmacy (ACCP) (Must provide official transcripts at time of interview)
Licensed as a Pharmacist in the State of Illinois or the ability to obtain license prior to starting employment (Must provide proof at time of interview if already obtained)
Two (2) years of experience providing patient-centered services
Prior experience working within a Managed Care setting
Prior experience working with Pharmacy Benefit Manager (PBM) software
Proficient with Microsoft Office
Board certified in a clinical specialty and/or has completed an accredited residency program in a clinical pharmacy practice (Must provide proof at time of interview)
Three (3) years of experience within a Managed Care setting
When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service
To take advantage of this preference a Veteran must :
Meet the minimum qualifications for the position.
Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, "Are you a Military Veteran?"
Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation at time of application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11). Discharge papers must list and Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable.
A copy of a valid State ID Card or Driver's License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing.
If items are not attached, you will not be eligible for Veteran Preference
VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER'S LICENSE AT TIME OF INTERVIEW.
Medical, Dental, and Vision Coverage
Basic Term Life Insurance
Pension Plan and Deferred Compensation Program
Employee Assistance Program
Paid Holidays, Vacation, and Sick Time
You may also qualify for the Public Service Loan Forgiveness Program (PSLF)
MUST MEET ALL REQUIRED QUALIFICATIONS AT TIME OF APPLICATION FILING.
Degrees awarded outside of the United States with the exception of those awarded in one of the United States' territories and Canada must be credentialed by an approved U.S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview.
*Please note all offers of Employment are contingent upon the following conditions: satisfactory professional & employment references, healthcare and criminal background checks, appropriate licensure/certifications and the successful completion of a physical and pre-employment drug screen.
*CCHHS is strictly prohibited from conditioning, basing or knowingly prejudicing or affecting any term or aspect of County employment or hiring upon or because of anypolitical reason or factor.
COOK COUNTY GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER.
Internal Number: 251041
About Cook County Health
ABOUT COOK COUNTY HEALTH (CCH)
The Cook County Health’s mission is to deliver integrated health services with dignity and respect regardless of a patient’s ability to pay; foster partnerships with other health providers and communities to enhance the health of the public; and advocate for policies that promote the physical, mental and social wellbeing of the people of Cook County.
CCH is comprised of two hospitals, John H. Stroger, Jr. Hospital and Provident Hospital, a robust network of more than a dozen community health centers, the Ruth M. Rothstein CORE Center, the Community Triage Center, the Cook County Department of Public Health, Cermak Health Services, which provides health care to individuals at the Cook County Jail and the Juvenile Temporary Detention Center, and CountyCare, a Medicaid managed care health plan.
The system cares for more than 300,000 patients each year and its physicians are experts in their fields, committed to providing their patients with comprehensive, compassionate and cutting-edge care. Today, CCH is transforming the provision of health care in Cook County by promoting community-based primary and preventive care, growing an innovative, ...collaborative health plan and enhancing the patient experience.
COOK COUNTY HEALTH IS AN EQUAL OPPORTUNITY EMPLOYER