Clinical Pharmacist, Pharmacy Benefits - Healthfirst
Remote, NY
About the Job
Duties & Responsibilities:
+ Works collaboratively to oversee clinical operations of assigned pharmacy benefits
+ Provides clinical pharmacy support for the pharmacy benefit including but not limited to: override requests, external appeals, program design, program implementation/oversight, content creation, training material development, and involvement in the annual Medicare BID and Commercial Product Pharmacy Benefit design
+ Collaborates with the Pharmacy Finance Manager, Special Investigations Unit, and PBM to address drug cost trends for assigned plans
+ Works with the Finance team to monitor PBM data and activities
+ Reviews member, provider, and pharmacy reports, and provides feedback on trends, ideas for improved management, and innovation
+ Manages cross-functional projects between Pharmacy and other HF business units
+ Collaborates to develop and manage drug related medical coverage policies and formulary for all lines of business
+ Presents during monthly Pharmacy Leadership meetings and the Pharmacy Advisory Committee as needed
+ Oversees and maintains compliance with all State and Federal agencies
+ Precepts Pharmacy Residents and Students
+ Additional duties as necessary
Minimum Qualifications:
+ Pharmacy degree from an accredited school of pharmacy is required
+ Registered Pharmacist with a state license in good standing required
+ Strong clinical knowledge of pharmaceuticals and disease states in an effort to identify and recommend opportunities for trend management
+ Demonstrated critical thinking and problem-solving skills
+ Ability to lead large and small working meetings
+ Strong clinical writing, verbal, and presentation skills
+ PC Skills with Microsoft Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables)
+ Passion for learning/ teaching, promoting access to healthcare, and interest in growing skills in a dynamic environment with various opportunities
Preferred Qualifications:
+ PGY1 Managed Care Residency (optional)
+ Knowledge of regulations of the Centers for Medicare and Medicaid Services and the New York State Department of Health
+ Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefits
+ Registered Pharmacist in the state of New York with a license in good standing
+ Experience with pharmacy benefit management oversight including maintaining policies and procedures related to formulary design and utilization management processes
Compliance & Regulatory Responsibilities:
Assists in regulatory and compliance audits for all plans. Ensure all activities are conducted in compliance with regulations.
License/Certification: Licensed pharmacist in good standing.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are 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 the performance of the work involved.
+ Works collaboratively to oversee clinical operations of assigned pharmacy benefits
+ Provides clinical pharmacy support for the pharmacy benefit including but not limited to: override requests, external appeals, program design, program implementation/oversight, content creation, training material development, and involvement in the annual Medicare BID and Commercial Product Pharmacy Benefit design
+ Collaborates with the Pharmacy Finance Manager, Special Investigations Unit, and PBM to address drug cost trends for assigned plans
+ Works with the Finance team to monitor PBM data and activities
+ Reviews member, provider, and pharmacy reports, and provides feedback on trends, ideas for improved management, and innovation
+ Manages cross-functional projects between Pharmacy and other HF business units
+ Collaborates to develop and manage drug related medical coverage policies and formulary for all lines of business
+ Presents during monthly Pharmacy Leadership meetings and the Pharmacy Advisory Committee as needed
+ Oversees and maintains compliance with all State and Federal agencies
+ Precepts Pharmacy Residents and Students
+ Additional duties as necessary
Minimum Qualifications:
+ Pharmacy degree from an accredited school of pharmacy is required
+ Registered Pharmacist with a state license in good standing required
+ Strong clinical knowledge of pharmaceuticals and disease states in an effort to identify and recommend opportunities for trend management
+ Demonstrated critical thinking and problem-solving skills
+ Ability to lead large and small working meetings
+ Strong clinical writing, verbal, and presentation skills
+ PC Skills with Microsoft Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables)
+ Passion for learning/ teaching, promoting access to healthcare, and interest in growing skills in a dynamic environment with various opportunities
Preferred Qualifications:
+ PGY1 Managed Care Residency (optional)
+ Knowledge of regulations of the Centers for Medicare and Medicaid Services and the New York State Department of Health
+ Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefits
+ Registered Pharmacist in the state of New York with a license in good standing
+ Experience with pharmacy benefit management oversight including maintaining policies and procedures related to formulary design and utilization management processes
Compliance & Regulatory Responsibilities:
Assists in regulatory and compliance audits for all plans. Ensure all activities are conducted in compliance with regulations.
License/Certification: Licensed pharmacist in good standing.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are 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 the performance of the work involved.
Source : Healthfirst
