Clinical Pharmacist Specialist

2 weeks ago


Missouri, United States Highmark Health Full time

Overview


We are seeking a highly skilled Clinical Pharmacist Specialist to join our team at Highmark Health. This role is responsible for monitoring FDA-approvals, drug manufacturer pipelines, and assessing drug utilization reports to develop and execute the Organization's Drug Formulary.



About the Role


This is a challenging and rewarding opportunity for a motivated professional with a strong background in clinical pharmacy management. The successful candidate will have experience in developing and implementing utilization management programs, including prior authorization, dose and duration edits, quantity limits, step-care edits, generic sampling medical policy review and development, and member-facing outreach initiatives.



Responsibilities



  1. Monitor FDA-approvals, drug manufacturer pipelines, assess drug utilization reports, and write drug monographs for Committee review to develop the Organization's Drug formulary and/or provide recommendations for NDC code capture, and monthly identification of high-risk members.
  2. Assist in the development of Gateway's Drug Formularies by monitoring FDA-approvals and drug manufacturer pipelines, assessing drug utilization reports, and writing drug monographs for Pharmacy & Therapeutics Committee review.
  3. Assist in the development and implementation of utilization management programs, including but not limited to: prior authorization, dose and duration edits, quantity limits, step-care edits, generic sampling medical policy review and development, and member-facing outreach initiatives.
  4. Develop and implement physician, pharmacy, account, and member educational initiatives that promote the Organization's Formularies, utilization management programs, and disease management initiatives.
  5. Provide clinical review and decisions, including but not limited to: physician and member appeals, member or provider information/education.
  6. Participate on cross-functional committees to develop and implement clinical and operational initiatives within Integrated Clinical Services. May participate in outreach efforts as needed to effectively reach goals of Medication Therapy Management programs, including Comprehensive Medication Reviews and Targeted Medication Reviews.
  7. Identify and assist in managing department process improvements to maximize overall efficiencies.
  8. Manage individual projects for timely review with the Director, Clinical Pharmacy.
  9. Participate in Medicare Stars performance measures to drive contribution to excellence (5 Stars).


Requirements



  • 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.
  • An understanding of managed care principles and practices is essential.
  • Demonstration of strong verbal and written communication skills, as well as, proficiency in the use of computer-based data processing.
  • Microsoft Office products, and database applications.
  • Pharmacy license.


Preferred Qualifications



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


About the Compensation


The estimated annual salary for this role is between $120,000 and $160,000 depending on experience and qualifications.



About Highmark Health


Highmark Health is an equal employment opportunity employer and welcomes applications from diverse candidates. We strive to make our website accessible to any user. If you need assistance completing the application process, please contact HR Services Online.



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