Senior Pharmacist

3 weeks ago


Columbus, Ohio, United States Highmark Health Full time

Job Summary

This role works in a team-oriented environment to monitor FDA approvals, drug manufacturer pipelines, and assess drug utilization reports to develop and execute the organization's drug formulary. The incumbent may write drug monographs for committee review, develop and implement management programs, and recommend codes for pharmaceutical-based reporting. The pharmacist will also review UM requests, provide consultation on case and disease management, and consult with medical directors as needed.

Essential Responsibilities

  • Monitor FDA approvals, drug manufacturer pipelines, and assess drug utilization reports to develop the organization's drug formulary.
  • Write drug monographs for committee review and provide recommendations for NDC code capture.
  • Develop and implement management programs, including prior authorization, dose and duration edits, quantity limits, and step-care edits.
  • Provide clinical review and decisions, including physician and member appeals.
  • Participate on cross-functional committees to develop and implement clinical and operational initiatives.

Qualifications

Required

  • Bachelor of Science in Pharmacy with experience in clinical/formulary management or a Doctor of Pharmacy degree with experience in clinical formulary management.
  • 5 years of related, progressive experience in the area of specialization.
  • Understanding of managed care principles and practices.
  • Demonstration of strong verbal and written communication skills, as well as proficiency in the use of computer-based data processing.
  • Pharmacy license.

Preferred

  • Medicare knowledge.
  • Prioritization skills.
  • Knowledge of Excel.
  • Knowledge of the HPMS system or CMS audit.

Skills

  • Ability to quickly identify and prioritize essential elements of problems.
  • Independently or in a team, ability to identify the root issues and formulate potential solutions.
  • Accurately use logic and reasoning in identifying alternate solutions, conclusions, or approaches to problems.

Physical, Mental Demands, and Working Conditions

Position Type

Office-based.

Teaches/trains others regularly.

Occasionally.

Travel regularly from the office to various work sites or from site-to-site.

Rarely.

Works primarily out-of-the office selling products/services (sales employees).

Never.

Physical work site required.

Yes.

Lifting: up to 10 pounds.

Constantly.

Lifting: 10 to 25 pounds.

Occasionally.

Lifting: 25 to 50 pounds.

Rarely.


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