Pharmacist
Your Impact:
- Review and determine prior authorization requests and appeals for medications covered under the Oregon Health Plan (OHP), ensuring compliance with medical necessity, state rules, and clinical guidelines.
- Stay current on Oregon Administrative Rules (OAR) and the Health Evidence Review Commission (HERC) Prioritized List to support coverage determinations and care review processes.
- Analyze claims data and utilization trends to evaluate appropriateness, effectiveness, and cost of medication services across the care continuum.
- Participate in Interdisciplinary Care Team (ICT) meetings to support coordinated member care planning and medical management initiatives.
- Support formulary management activities, including configuration change requests and collaboration with the pharmacy benefit manager (PBM).
- Prepare clinical documents such as drug monographs and evidence reviews for UHA’s Pharmacy & Therapeutics (P&T) Committee.
- Assist in developing, applying, and updating clinical criteria for managing pharmacy and medical benefit drug coverage.
- Execute daily responsibilities within the Medication Management program, including medication therapy management (MTM), medication reconciliation, targeted follow-up, and patient outreach.
- Provide medication counseling and education to members under the supervision of a licensed pharmacist, ensuring understanding of therapies and adherence.
- Assist in coordinating medication-related services across departments, resolving barriers and streamlining access for members and providers.
- Support member education related to pharmacy benefits, rights, and responsibilities; collaborate with grievance and appeals teams as needed.
- Respond to pharmacy inquiries to prevent care delays, ensure timely medication access, and maintain strong community partnerships.
- Contribute to policy and procedure development, workflow optimization, and system-wide quality improvement initiatives.
- Perform other duties as assigned to support Umpqua Health’s Vision, Mission, and Organizational Values.
Your Credentials:
- PharmD from an accredited school of pharmacy.
- Current and active Oregon Board of Pharmacy license or eligibility for licensure in Oregon.
- Minimum of 2 years’ experience in a clinical pharmacy setting; managed care and population health experience strongly preferred.
- Proficiency in interpreting claims data, clinical analytics, and reporting.
- Strong understanding of Oregon Health Plan, Oregon Administrative Rules (OAR), and Medicare Part D preferred.
- Demonstrated knowledge of quality improvement frameworks and experience supporting related initiatives.
- Excellent interpersonal, written, and verbal communication skills.
- Proven time management and critical thinking abilities in a fast-paced healthcare environment.
- No current suspension, exclusion, or debarment from participation in federal healthcare programs.
About Umpqua Health
At Umpqua Health, we're more than just a healthcare organization; we're a community-driven Coordinated Care Organization (CCO) committed to improving the health and well-being of individuals and families throughout our region. Umpqua Health serves Douglas County, Oregon, where we prioritize personalized care and innovative solutions to meet the diverse needs of our members. Our comprehensive services include primary care, specialty care, behavioral health services, and care coordination to ensure our members receive holistic, integrated healthcare. Our collaborative approach fosters a supportive environment where every team member plays a vital role in our mission to provide accessible, high-quality healthcare services. From preventative care to managing chronic conditions, we're dedicated to empowering healthier lives and building a stronger, healthier community together. Join us in making a difference at Umpqua Health.
Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.