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Washington State Apple Health Drug Utilization Review Specialist (MAPS 3/CQCT) in Olympia, Washington

Description Apple Health Drug Utilization Review Specialist (MAPS 3/CQCT) 71029045 This position is relied upon for timely review and analysis of drug utilization patterns. If you pride yourself on a project management approach to your work, and the ability to communicate complex facts, and recommendations clearly and effectively this may be the opportunity for you! Position Objective: This Medical Assistance Program Specialist 3 position is the Apple Health Drug Utilization Review Specialist. This position is a subject matter expert in reviewing and analyzing drug utilization patterns, pharmacy communications to internal and external stakeholders, as well as oversees operational policies and procedures for the pharmacy program. The Apple Health Drug Utilization Review Specialist is a full-time position within the Prescription Drug Program, reporting to the Pharmacy Unit Manager. Some of what you will do: * Designs, develops, and analyzes drug utilization review reports. * Works with the Strategic Clinical Pharmacist and the Data Analytics team to design, develop, run, and analyze drug utilization review reports to identify utilization trends, manage workload, and monitor the performance of ongoing clinical policies or prior authorization initiatives. * Provides verbal and/or written analysis along with recommendations based on utilization analysis. Directly responsible for overseeing operational policies and procedures for the pharmacy program. * Documents in writing internal processes and procedures. * Conducts annual reviews of program processes and procedures for accuracy and consistency. Directly responsible for pharmacy communications, publications, and web content/materials for the pharmacy program * Determines necessary and most appropriate media for publication (one or more of the following: Numbered Memo, Billing Instruction, Broadcast Fax, Website, policy paper, prescriber mailing). * Drafts contents of publication, and coordinate review through agency review processes. Coordinates the DUR board meetings. * Assists with planning and scheduling of drug class reviews for the PDL. * Coordinates projects related to DUR and PDL to capture scope and objectives, develop and maintain project work plans including tasks, schedules, and sets priorities and prepares communication for stakeholders. *Required Qualifications: * A Master’s degree from an accredited college with a major study in public health, public administration, business administration, social work, or closely related field *AND Three years supervisory or consultative experience in health services, social service, Medicaid, or social security disability programs. OR A bachelor’s degree for an accredited college with a major study in public health, public administration, business administration, social work, or closely related field AND Five years supervisory or consultative experience in health services, social service, Medicaid, or social security disability programs. OR One year as a Medical Assistance Program Specialist 2 * Experience and understanding of managed care, Medicaid, and health reform efforts including the ACA. * Demonstrated analytical skills including the ability to synthesize and summarize large amounts of information and to focus quickly on the essence of the issue. * Demonstrated ability to translate complex information into digestible and actionable report products. Preferred Qualifications: Knowledge of continuous quality improvement practices. Knowledge of methods of practice of research, analysis, and report writing at an independent level. Skills to: * Communicate complex facts and recommendations clearly, effectively, concisely, and accurately, in writing and orally. * Coordinate and work effectively with program staff and management, practitioners, and government entities. * Use a variety of research tools. * Analyze data effectively to provide administrators with relevant information. * Apply systems theory in the analysis of effective technical and procedural workflows. ABOUT HCA The Washington State Health Care Authority (HCA) purchases health care for more than 2 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and, beginning in 2020, the School Employees Benefits Board (SEBB) Program. Our agency is committed to whole person care, integrating physical health and behavioral health services for better results and healthier residents. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost. What we have to offer: * Meaningful work with friendly co-workers who care about those we serve _Voices of HCA_ * A clear agency mission that drives our work and is person-centered _HCA’s Mission, Vision & Values_ * A healthy work/life balance, including alternative/flexible schedules and mobile work options. * Infants in the workplace _Infants at the Workplace Video_ * A great total compensation and benefit package _WA State Government Benefits_ * A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby. _ * _Tuition reimbursement. * And free parking! About Olympia and Washington State Washington State offers a total work/life package of pay, benefits, flexibility, and workplace opportunities to help you get the most out of your career and out of life. Washington State is a great place to work, play, and be a part of a community, offering quality of life that is unsurpassed. From the high energy urban center of Seattle, one of the nation’s top ranked cities, to the more relaxed pace of our rural communities, Washington’s distinctive Northwest lifestyle blends a progressive, creative culture with a casual nature. *How to Apply: * Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position, you will need to complete your profile and attach: * A cover letter that specifically addresses how you meet the qualifications for this position. * Current resume. * Three professional references, including a minimum of one past supervisor. If you have questions about the process, or need reasonable accommodation, please contact the recruiter before the posting closes. Washington State is an equal opportunity employer. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may call the Human Resources Office at 360.725.1723 or email Elise.Drennen@hca.wa.gov. *Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment but will be considered in determining the applicant’s suitability and competence to perform in the position. * Salary: $61,224.00 - $80,292.00 Annually Location: Thurston County – Olympia, WA Job Type: Full Time - Permanent Department: Health Care Authority Job Number: 2021-05932 Closing: Continuous Agency: State of Washington Address: View Job Posting for Agency Information View Job Posting for Location, Washington, 98504 Phone: View Posting for Agency Contact Website: http://www.careers.wa.gov

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