Clinical Practice Pharmacist - Revenue Integrity and Patient Access

EDUCATION & EXPERIENCE

Minimum Qualifications:

• Bachelor of Science in Pharmacy or Doctor of Pharmacy degree.
• Completion of an ASHP accredited post-graduate year 1 residency program or 3 years of related experience.

LICENSES, REGISTRATIONS OR CERTIFICATIONS

Required:

• Licensed to practice pharmacy in the state of Texas or eligible for licensure from the Texas State Board of Pharmacy.
• Must be licensed with the Texas State Board of Pharmacy within 90 days of hire.

Preferred Qualifications:

• Doctor of Pharmacy degree
• Completion of an ASHP accredited post-graduate year 2 residency program in Internal Medicine
• Experience as a Pharmacist in Internal Medicine

JOB DESCRIPTION

The Clinical Practice Pharmacist provides advanced medication therapy management and direct or consultative patient care services across assigned practice areas. This role integrates clinical decision-making with operational awareness to ensure safe, effective, and cost-conscious medication use in alignment with departmental and system goals.

The Clinical Practice Pharmacist actively participates in interprofessional care teams, applies evidence-based guidelines, manages medication therapy to achieve optimal outcomes, and contributes to the standardization of clinical pharmacy services across sites of care. Practice settings may include inpatient decentralized/unit-based care, ambulatory/specialty pharmacy, infusion services, prior authorization or medication access programs, and revenue integrity functions.

ESSENTIAL JOB FUNCTIONS

• Assess medication regimens, identify and resolve therapy-related problems, and provide recommendations to optimize clinical outcomes and cost-effectiveness.
• Monitor and evaluate therapeutic responses and adverse events, adjusting therapy per protocol or in collaboration with prescribers.
• Implement evidence-based guidelines, internal policies, and applicable external payer or regulatory requirements to ensure appropriate, safe, and cost-effective therapy selection.
• Partner with physicians, nurses, case managers, and other healthcare professionals to support coordinated, patient-centered care.
• Participate in patient care rounds, case conferences, and interdepartmental meetings as assigned.
• Serve as a clinical resource for drug information, policy interpretation, and therapeutic decision-making providing evidence-based recommendations to other healthcare professionals.
• Support safe and efficient medication distribution by collaborating with operational staff to address workflow, product selection, and inventory issues impacting clinical care.
• Identify and escalate medication-use system issues that require quality or safety intervention.
• Educate patients on their medications, including how to take them correctly, potential side effects, and the importance of adherence.
• Collaborates with physicians, nurses, and other healthcare professionals to ensure coordinated and safe patient care.
• Assist in implementing and supporting medication-use evaluations (MUEs), quality improvement projects, and initiatives aligned with departmental and system goals.
• Participate in developing and refining clinical pathways, collaborative practice agreements, and protocol-driven services
• Support compliance with relevant accreditation and regulatory standards (TJC, CMS, USP, state board) as they relate to clinical practice.
• Promptly identify and report medication safety events, near misses, and hazards through established reporting systems, and participate in follow-up discussions or improvement actions as directed.
• Provide orientation, competency training, and ongoing education for pharmacists, technicians, residents, and students.
• Precept pharmacy learners including pharmacy residents and participate in experiential education activities (IPPE/APPE) in collaboration with residency and academic program leaders.

Revenue Integrity and Patient Access related functions:

• Evaluates and reviews all prior authorization requests and render coverage determinations based on clinical criteria and plan design.
• Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources to identify formulary alternatives or qualification for co-pay, drug replacement, and/or patient assistance programs when appropriate.
• Ensures orders are sent to and patients are referred to the appropriate outpatient pharmacy or infusion clinic when appropriate.
• Reviews payer contracts/medical coverage policies to understand reimbursement terms and ensure accurate billing based on contract/policy specifications.
• Manages and completes daily infusion referrals work-queues for accuracy and completeness prior to payer submission in a timely manner.
• Identifies and addresses discrepancies in charge capture practices for infusion services by reviewing documentations for appropriate level of detail to support billing codes.
• Assists with developing strategies to prevent future denials by addressing issues with documentation, coding, and billing practices.
• Partners with health system billing/revenue cycle team to appeal denied claims where appropriate.
• Assist with generating reports on key revenue integrity metrics, such as charge capture rates, coding accuracy, denial trends, etc.
• Utilize data analytics tools to identify areas for improvement and prioritize revenue integrity initiatives.

KNOWLEDGE/SKILLS/ABILITIES

• Strong clinical knowledge across primary and specialty disease states relevant to assigned practice area(s).
• Excellent communication and interpersonal skills with a high degree of professionalism and competence in dealing with a variety of professionals within various backgrounds.
• Effective collaboration and communication skills with multidisciplinary teams.
• Ability to develop, organize, and accomplish goals. Ability to develop, implement and lead all aspects of pharmacy operation.
• Proficiency in medication-use systems and related technology (e.g., EHR, CPOE, ADCs, bar-code verification).
• Ability to analyze / evaluate data and make appropriate recommendations / decisions.
• Capability to adapt clinical skills across multiple practice environments.
• Effective problem-solving skills.

Equal Employment Opportunity

UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.

Compensation