Company: Ampcus Incorporated
Posted on: January 25, 2023
This position serves as internal and outward-facing, dedicated
clinical resource responsible for quality measures supporting the
pharmacy department in identifying Star/HEDIS measure needs and
expectations, and developing and managing initiatives to achieve 5
stars. The position has oversight responsibilities driven by
metrics to manage vendors, retail pharmacy , prime, Magellan and
health systems to deliver outcomes as outlined in different
programs as well as reporting to internal stake holders
Major Responsibilities (4 to 8 in total)
The information above is intended to describe the general nature of
the work being performed by each incumbent assigned to this
position. This job description is not designed to be an exhaustive
list of all responsibilities, duties, and skills required of each
- Clinical pharmacist will be responsible for managing outreach
efforts and pull-through for Star/HEDIS clinical programs.
Coordinate between the pharmacy department, health systems, and
Magellan. Clinical pharmacist will be responsible for driving
results to obtain 5-Stars for Medicare Part D Star clinical
programs including Adherence (DM, RAS, Statins), SUPD, and CMRs for
- Oversee the daily clinical activities related to Star/HEDIS
measure goals for various health systems. Ensure clinical goals and
objectives are met.
- Identify problems related to Star/HEDIS measures that require a
clinical solution, implement and monitor clinical pharmacy
solutions in support of Horizon's Star/HEDIS goals to save money
and improve care. Major responsibility is to serve as clinical
liaison between Horizon pharmacy department and health systems,
assisting with managing overall relationship and driving adoption
of recommended clinical solutions.
- Develop, review and monitor clinical programs, therapeutic
initiatives, pathways of care and other drug use policies and
practices in support of Star/HEDIS initiatives. Works closely with
the pharmacy department managers, vendors, and health systems to
ensure execution of programs.
- Maintain continuity among health systems by communicating and
documenting program design and execution in accordance with
pharmacy department expectations. Track, analyze and report on
patient interventions, interactions and findings of disease
- With support of the Horizon data team, develop and track the
appropriate metrics to monitor the quality, care, and cost impact
of the Star/HEDIS program and monitor overall healthcare trends
within the Medicare populations.
- Conduct member, provider, and pharmacy outreach/interventions
and Comprehensive Medication Reviews as needed to achieve Stars
- The position requires communication across all departments; an
understanding of the strategic impact of the programs; and
extensive knowledge of how the Star/HEDIS programs integrate with
other clinical initiatives.
- Understand the financial impact of all clinical
recommendations: Programs must address the impact on customers,
operations, program integrity, pricing, quality and
BA/BS in Pharmacy or PharmD
Field(s) of study: Pharmacy
- Health plan or Medicare clinical customer service or Retail
management position .
- Project management experience and knowledge of health plans or
- CMS Star/HEDIS measure quality improvement metrics.
Industry: Healthcare; preferably with retail or health insurance
Additional licensing, certifications, registrations: A current
Pharmacist license in the state of New Jersey
- CMS Star/HEDIS measures.
Skills and Abilities:
- Able to receive assignments in the form of high level
objectives and independently establish detailed goals to meet
- Strong interpersonal skills. Excellent oral and written
- Ability to function independently and as a team
- Good organization and time management, with the ability to
manage multiple tasks.
- Proven ability to plan, organize, schedule, direct, control and
monitor project activities.
- Able to perform basic financial analysis.
- Ability to interact at a high level with external contacts.
Develop reporting and tracking documents with visuals
Computer Skills: Microsoft Office Suite, access, excel, project
management, power point
For more information please contact Priya Jagtap at (703) 574-1407
Since 1995, iTech Solutions Inc., has been providing IT Consulting
and Direct Hire Services to the Insurance, Financial,
Communications, Manufacturing - and Government sectors with local
offices in Connecticut, Minnesota, Colorado, - Massachusetts,
Tennessee, North Carolina, and New Jersey / Pennsylvania area.
Our recruiting strategy is simple, if you want to find qualified IT
professionals then use IT professionals to find them. - - So at
iTech Solutions, - our personnel are all career IT professionals
with a wide range of IT experience. - We can honestly say our staff
understands the technologies, the complexities of finding and
selecting the appropriate personnel and the pressures of running
successful IT projects. - -
Employer will not sponsor applicants for any employment visas, at
hiring or in the future, including but not limited to H-1B visas.
-Corp-to-Corp or subcontract personnel will not be considered for
Keywords: Ampcus Incorporated, Newark , Clinical Pharmacist, Healthcare , Newark, New Jersey
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