The New York City-based Sr. Clinical Consultant will support quality and safety, within the Express Scripts Physician Engagement and Academic Detailing Department. They will ensure all prescriber and member engagement initiatives are established and supported, performed according to specifications, and that clinical criteria are appropriate, and in agreement with Client's intent. The employee's focus will be on QARR/HEDIS/Quality oversight and initiatives with an overall objective to improve QARR pharmacy quality metrics to meet or exceed statewide average, each to the extent reasonably practicable based upon their specific job performance and qualifications.

Provides detailed patient profile reviews specific to Client's Medicaid population to ensure optimal health outcomes for patients and lower total healthcare costs. The Sr. Clinical Consultant serves as a clinical liaison to prescribers and their staff regarding Client's pharmacy programs, provides timely responses to inquiries, and maintains a record of academic detailing activities and results, as appropriate but expressly including member and prescriber outreach, education, facilitation and ensuring appropriate prescription trends (individual and aggregate) and adherence.


* Addresses overall gaps in HEDIS/QARR/HIVQUAL with patients and prescribers. Continually monitoring NY state QARR/HEDIS/quality metrics and actively developing strategy in collaboration with Client to improve overall scores
* Performs telephone counseling sessions with prescribers and their support staff regarding clinical, quality, gaps in care, and safety
* Actively participate in Client pharmacy staff meetings, as determined necessary by VP of Pharmacy
* Utilizes multiple data analytics tools and case management information to monitor and analyze trends in Client's prescribing, and collaborates with Client, ESI's account team, and others to optimize opportunities to educate prescribers with the goal to improve quality
* Delivers patient-facing services including comprehensive medication program reviews, pharmacotherapy consults (by referral from patient's case management team), targeted medication reviews, and disease-specific medication reviews to assess appropriateness of all medications, adherence to treatment plan, optimize medication therapy (via recommendations made to provider), and improve clinical outcomes and quality. Supports nurse case managers and existing staff with clinical review of patients and necessary outreach
* Submits bi-weekly worksheets regarding (but not limited to) allocation of time, fulfillment of obligations, and participation in meetings in a form and manner as required by Client for review and approval
* Assists with compliance and oversight of overall prior authorization process, as requested
* Maintains record of activity and tracks clinical and financial impact to Client, and provides this information to Client's Pharmacy department
* Participates and contributes in formal and informal training programs and professional development activities which may include taking, developing, and/or conducting sessions


* Doctor of Pharmacy, with completed pharmacy residency preferred
* 3-5 years general pharmacy experience; 2+ years in managed care, the PBM industry, or pharmaceutical sales preferred

* Licensed New York State pharmacist in good standing, credentialing as a BCPT, HIV Expert or HIV pharmacist preferred

* Proficiency in using Microsoft Office applications.
* Excellent verbal, presentation, and written communication skills in English required (Spanish Preferred)
* Proven leadership skills, team-orientation, a proactive management style and strong commitment to client service a must
* Proven leadership skills, team-orientation, a proactive management style and strong commitment to client service a must
* Ability to work on multiple tasks, prioritize, resolve complex issues, and have strong project management skills
* Ability to learn multiple internal reporting and analytic tools use advanced problem solving skills; work independently, as well as collaboratively
* Knowledge of PBM industry/Managed care/Value Based healthcare industry is desirable
* Position located within the NYC (or surrounding) area; travel necessary to visit prescribers
* May be required to frequently work onsite at Client in New York City
* LI-JN1


The Clinical Research & New Solutions department, housed in our state-of-the-art lab, is responsible for developing and managing programs and services that allow our 100 million members to make better health-related choices. Rooted in health decision science, this department includes Knowledge Solutions, Customer Solutions, Consumer Solutions, Research & New Solutions and Clinical Services.


At Express Scripts, we dare to imagine a better health care system, and we're driven to make it happen. Where some see obstacles, we see possibilities. We're challengers, difference-makers and opportunity-seekers, united with our partners in pursuit of a simpler, more sustainable system and better health for all.

We have always acted first to take on the toughest challenges. We uniquely partner across the health care ecosystem to uncover opportunities, take action, advance health care and deliver better outcomes - like no one else can. We believe health care can do more. We are Champions For BetterSM.

Express Scripts, part of Cigna Corporation, unlocks new value in pharmacy, medical and beyond to further total health for all.

Associated topics: bhlex, care, certified, certified medication aide, chha, gmc, midwife, patient care, patient care technician, rss

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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