Clinical Pharmacy Support Specialist
3 weeks ago
We are seeking a highly skilled Pharmacist Clinical Provider Support to join our team at Elevance Health. As a key member of our clinical pharmacy team, you will play a critical role in providing clinical pharmacy support to Medicare, Commercial, and Medicaid providers.
Your primary responsibility will be to improve quality and cost measures through close collaboration with providers engaged in value-based care arrangements. You will work closely with our clinical team to develop and implement strategies to improve member health and reduce the total cost of care.
Key Responsibilities- Provide clinical pharmacy support to providers, including suggesting best practices to support core clinical programs such as formulary management.
- Research and synthesize detailed clinical data related to pharmaceuticals to assist contracted physician prescribers in achieving formulary and quality goals.
- Serve as a clinical resource to external prescribing providers and pharmacists on areas such as prospective, inpatient and retrospective DURs and provide dosage conversion and clinical support for therapeutic interventions.
- Prepare information for network physicians utilizing data within provider tools utilizing Excel, Tableau, etc.
- Support network physicians by analyzing organizational and practice-level reports and identifying opportunities to improve pharmacy quality (STAR, HEDIS, etc.) and reduce pharmacy cost.
- Attend external provider meetings to communicate practice-level pharmacy goals and opportunities for reaching goals.
- Educate internal matrix provider partners about pharmacy programs and goals.
- Field questions from providers related to Pharmacy programs (benefits, reporting tools, CMS, formulary, etc.).
- Participate in development and testing of pharmacy provider tools with the lens of a clinical user.
- Closely monitor and report on pharmacy quality and cost metrics.
- Requires BA/BS in Pharmacy.
- Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience; or any combination of education and experience, which would provide an equivalent background.
- Requires a registered pharmacist.
- Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh).
- PharmD preferred.
- Experience with Medicaid programs, particularly in Florida preferred.
- Microsoft Excel experience strongly preferred.
- PBM or managed care experience strongly preferred.
- Passionate about building relationships with external provider partners to improve member health preferred.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.
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