Pharmaceutical Care Specialist

2 months ago

Monsey, New York, United States Health First Full time

Key Responsibilities:
Facilitate initiatives aimed at addressing care gaps through direct outreach to providers and members, collaborating with provider engagement, and utilizing our pharmacy network capabilities.

Ensure that all clinical recommendations align with the most recent guidelines or are otherwise substantiated by clinical compendia.

Provide expert clinical pharmacy support to pharmacy technicians as they engage with members regarding medication adherence, tackle existing barriers to adherence, and employ motivational interviewing techniques to enhance member health outcomes.

Work collaboratively with internal teams such as Marketing, IT, and Enterprise Analytics to aid in the development of strategic digital communication channels for member outreach.

Identify and promptly address same-day grievances reported by members in accordance with our established policies and procedures.

Oversee compliance with all relevant State and Federal regulations.

Mentor Pharmacy Residents and Students.

Ensure adherence to clinical criteria as mandated by the Centers for Medicare and Medicaid Services (CMS) and the New York State Department of Health (NYSDOH).

Conduct research on drug information to maintain up-to-date knowledge of pharmaceuticals and disease states.

Analyze monthly reports and provide insights on trends, efficiency improvements, and innovative ideas.

Perform additional duties as required.

Minimum Qualifications:
Pharmacy degree from an accredited institution.

Registered Pharmacist with a valid state license in good standing.

Experience in roles requiring clear, concise, and professional written and verbal clinical communication.

Familiarity with specialty pharmaceuticals and billing practices within medical and pharmacy benefits.

Preferred Qualifications:
Bilingual proficiency in English and one or more additional languages such as Spanish, Mandarin, or Cantonese may be advantageous based on business needs.

Ability to collaborate effectively within a team environment.

Demonstrated critical thinking and problem-solving abilities.

Commitment to continuous learning, promoting the pharmacy profession, and developing skills in a dynamic environment with diverse opportunities.

Knowledge of regulations from the Centers for Medicare and Medicaid Services, including National and Local Coverage Determinations.

Capacity to lead both large and small meetings.

Proficient in Microsoft Office Suite, including Outlook, Word, PowerPoint (for presentations), and Excel (including Pivot tables).

Compliance & Regulatory Responsibilities:
Assist in regulatory and compliance audits for all plans, ensuring all activities adhere to regulations.

License/Certification:
Licensed pharmacist in good standing.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER.

Applicants and employees are considered for positions and evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability, or any other protected Federal, State/Province, or Local status unrelated to job performance.

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