PGY1 Managed Care Residency

Providence Health Plan (PHP) is a not-for-profit health insurance provider that is part of an integrated healthcare system of Providence Health and Services (PH&S). Based in Oregon, PHP coordinates care with Providence hospitals, physician groups, home services, and specialty services. Additionally, PHP provides benefits for approximately 500,000 members across five states, including Medicare, Medicaid, Commercial, Administrative Services Only (ASO) groups, and Individual & Family plans.

The purpose of the PHP PGY-1 Managed Care Residency program is to prepare the resident for an active pharmacist role in the managed care setting. The program is designed to provide a solid foundation in population-based pharmaceutical care. Primary emphasis is placed on the development and implementation of medication use management initiatives and policies, medication therapy management, formulary management, quality and outcome assessment, drug information, and developing effective communication, teaching and mentoring skills.

By the end of the program, the resident should be able to:

  • Design and implement clinical programs to enhance the efficacy of patient care
  • Ensure the safety and quality of the medication-use system
  • Provide medication and practice-related information, education, and/or training
  • Collaborate with plan sponsors to design effective benefit structures to service a specific population's needs.
  • Exercise leadership and practice management skills
  • Demonstrate project management skills

The PHP Managed Care Residency Program has been accredited by the American Society of Health System Pharmacists since 1994 as a PGY-1 residency with managed care focus, and was granted accreditation as a PGY-1 managed care pharmacy residency program in 2013.

REQUIRED ROTATIONS Duration
Orientation 3 weeks
Formulary exception (prior authorization) training 6 weeks
Pharmacy benefits administration 6 weeks
Medication Therapy Management 6 weeks
Clinical Quality Management 6 weeks
Primary care at Providence Medical Group (PMG) 6 weeks
Pharmacy and Therapeutic Committee 6 weeks
Managed Care Practice Management Longitudinal
Major project Longitudinal
Practice-based staffing Longitudinal
ELECTIVE ROTATIONS
Case and disease management 4-6 weeks
Geriatric ambulatory care 4-6 weeks
Health-System Administration 4-6 weeks
Pharmacy Services Management 4-6 weeks
Home infusion/hospice 4-6 weeks
Teaching certificate program  

Rotations In-Depth

Formulary Exception (Prior Authorization) Training. This rotation teaches residents how to review prior authorizations and triage customer service requests that have escalated to the pharmacist-in-charge.

Clinical Quality Management. Residents review current population-based national quality objectives (NCQA, URAC and HEDIS), establish and implement monitoring plans, and design a process to improve a chosen measure.

Pharmacy Benefits Administration. Residents will learn aspects of pharmacy benefit management, drug utilization review, formulary management, pharmacy network development, disease management, quality assessment and Medicare Part D implementation in a large EPO/PPO/HMO health plan.

Medication Therapy Management (MTM). Residents will complete medication therapy management assessments, comprehensive medication review or targeted medication reviews when needed. They also will provide phone consultations to health plan members.

Primary Care (Providence Medical Group). Residents gain experience in a variety of primary care pharmacy services including collaborative disease state management, health care provider education, and quality improvement.

Pharmacy and Therapeutic (P&T) Committee. Residents engage in one full cycle of pharmacy and therapeutic (P&T) committee planning and organization, complete drug reviews, and present before the committee.

Managed Care Practice Management. Residents will participate in regular discussions regarding managed care, leadership, and pharmacy practice topics. Residents will continue to participate in P&T, and develop educational sessions for pharmacists (journal clubs, continuing education).

Practice-Based Staffing. Residents will staff at a Providence retail pharmacy location to develop independent clinical decision-making skills and gain real-world experience with managed care pharmacy claims processing and edits. Staffing will generally consist of one-two days every other week.

Case and Disease Management. Residents work with the PHP nursing team to review and design a therapeutic regimen, establish and implement monitoring plans, and provide drug information and individual patient consultations.

Geriatric Ambulatory Care (Providence ElderPlace). As part of a multidisciplinary team, clinical pharmacy specialists learn to design and manage pharmacotherapy for the frail elderly.

Health-System Administration. By participating in meetings with administrative leaders, residents will learn how a health plan works with other components of a health system (inpatient, long-term care, ambulatory care, specialty pharmacy, home infusion).

Pharmacy Services Management. Residents will work with PHP pharmacy leaders to gain knowledge of managing the various responsibilities of a large pharmacy department.

Home Infusion/Hospice. Residents will deliver pharmaceutical, specialty compounding and long-term care services to patients receiving home infusion. Residents also will go on home visits to patients receiving hospice care.

Oregon Pharmacist Teaching Certificate Program. Residents will enhance teaching skills through practical training and hands-on teaching experience.