Pharmacy Policy and Vendor Oversight Consultant
About the position The Pharmacy Policy and Vendor Oversight Consultant is a critical role responsible for reviewing and maintaining medical policies related to the safe, effective, and cost-efficient use of pharmacologic agents and healthcare services in conjunction with an external vendor. The role includes evaluating clinical evidence, revising policies, and collaborating with internal and external stakeholders to ensure the policies align with the latest standards of care and regulatory requirements. This position will have oversight of the external vendor and optimizing clinical practices through evidence-based policy development/review. The position will involve presenting clinical findings and performance of the vendor. Responsibilities • Collaborate with healthcare teams to monitor and improve the quality of medication management services. • Contribute to activities with vendor oversight and outcomes reporting. • Drive the review of medical policies, ensuring that policies reflect the most current published scientific literature and are actionable for clinical staff. • Monitor the external environment for new and evolving medical technology, reviewing online updates from sources like Hayes, CMS, NIH, AHRQ, and others, to inform policy updates. • Work in collaboration with the vendor to identify and resolve issues related to policy language, criteria, or operational implementation of policies. Requirements • Minimum of 5 years of clinical experience in healthcare, with expertise in medication management, clinical policy development, or healthcare utilization. • Experience with new drug review and application to clinical policy development. • Experience with medication therapy management, drug utilization reviews, and medical policy updates is required. • Project management or management experience in a clinical or health plan environment is required. • Bachelor's degree in a health services or clinical science field (such as Nursing, Public Health, Epidemiology, Biostatistics, or Health Technology) required. • Registered Nurse (RN), Nurse Practitioner (NP), or Physician Assistant (PA) licensure required. Nice-to-haves • Master's degree in healthcare or a business-related field is highly desirable. • Experience in medical policy development, clinical review, or health plan utilization management is highly preferred. • Experience working in interdisciplinary teams to optimize patient care and develop evidence-based medical guidelines is preferred. Benefits • Medical, Dental & Vision coverage • Retirement Plan • Generous time off including Paid Time Off, Holidays, and Volunteer time off • Incentive Plan • Tuition Reimbursement Apply tot his job