PGY1 Managed Care Residency–Portland

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 PH&S hospitals, clinics, physician groups, home services, and specialty services. Additionally, PHP provides benefits for over 650,000 members across several states, including Medicare, Medicaid, Commercial, Administrative Services Only (ASO) groups, and Individual & Family plans.

The purpose of the PGY-1 Managed Care Residency program is to build upon the Doctor of Pharmacy (Pharm.D.) education and outcomes to develop managed care pharmacist clinicians with diverse patient care, leadership and education skills who are eligible for board certification and postgraduate year two (PGY2) pharmacy residency training. A managed care residency will provide systematic training of pharmacists to achieve professional competence in the delivery of patient care and managed care pharmacy practice. 

To that end, the PHP PGY-1 Managed Care Residency program is dedicated to providing the resident with the knowledge and leadership skills needed to pursue a career in a practice environment focused on providing optimal drug therapy outcomes for large and diverse populations. 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, effective communication, teaching and mentoring skills. 

The PHP Managed Care PGY-1 Residency Program is dedicated to providing the resident with the knowledge, skills, and leadership ability necessary to pursue a practice environment focusing on optimal medication therapy outcomes for patients and populations. By the end of the residency program, the resident should be able to:

  • Understand how to manage the drug distribution process for an organization’s members 
  • 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 was 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 2-3 weeks
Formulary Exception (prior authorization) Training 6 weeks
Medication Therapy Management (MTM) 6 weeks
Pharmacy Benefits Administration 6 weeks
Clinical Quality Management 6 weeks
Pharmacy & Therapeutics Committee 5-6 weeks
Ambulatory Care Practice (Choose one)
  • Primary Care at Providence Medical Group (PMG)
  • Geriatric Care at Providence Elderplace
6 weeks
Managed Care Practice Management Longitudinal
Evidence-Based Medicine Longitudinal
Major project Longitudinal
Practice-based staffing Longitudinal
ELECTIVE ROTATIONS
Pharmacy Client Account Management 4-6 weeks
Health-System Administration 4-6 weeks
Specialty & Transitions of Care 4-6 weeks
Teaching Certificate Program Longitudinal

Rotations In-Depth

Orientation –Introduction to Providence Health and Services (PH&S) and Providence Health Plan (PHP) through new employee orientation (review of policy and procedures), hands-on training at PHP with basic computer skills, FACETS, DST (formerly Argus), and online training modules

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

Medication Therapy Management (MTM) – Residents will develop skills in all aspects of performing telephonic comprehensive medication reviews (CMR) and targeted medication reviews (TMR). The resident will function as an MTM pharmacist by the end of the rotation, providing appropriate patient and physician recommendations based off of interactions with patients.

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 health plan.

Clinical Quality Management – Residents review current population-based national quality objectives (NCQA, CMS 5-Stars and HEDIS), establish and implement monitoring plans, and design a process to improve a chosen measure.

Pharmacy and Therapeutic (P&T) Committee –Residents engage in the Oregon Region Pharmacy and Therapeutic (P&T) committee planning and organization, complete drug reviews, and present before the committee.

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.

Geriatric Ambulatory Care (Providence ElderPlace) – Geriatric Ambulatory Care (Providence Elder-At-Home). As part of a multidisciplinary team, residents learn to design and manage pharmacotherapy for medically fragile, home-bound patients. Residents will have the opportunity to make home visits to chronically ill patients and do full pharmacotherapy assessments.

Managed Care Practice Management – Residents will participate in regular discussions regarding managed care, leadership, and pharmacy practice topics to foster professional and personal growth.

Evidence-Based Medicine – Residents will continue to build upon skills learned during the P&T rotation by completing reviews/evaluations for ORPTC, develop educational sessions for pharmacists (e.g., journal clubs, continuing education), and answer drug information requests from colleagues and/or providers.

Practice-Based Staffing – Residents will staff in Medication Therapy Management or in prior authorization review at the health plan. Staffing will generally consist of one day per week.

Specialty & Transitions of Care – Residents are introduced to cost-management strategies for specialty medications. Residents will also provide MTM services in a Transitions of Care program that integrates pharmacy and care management teams in an effort to reduce hospital readmissions and optimize clinical outcomes..

Health-System Administration – By participating in meetings and projects 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 Client Account Management – Residents will support new and renewing business opportunities by collecting, analyzing, interpreting, and presenting health care cost and utilization information and inform clients how PHP’s clinical strategies contribute to lower total cost of care. Additionally, the resident will support the sales and account management team in the completion of requests for proposals for new business, including rate development, formulary disruptions, repricing, rebate forecasting and benefit design.

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