Health Outcomes Pharmacist

This is a fully remote position, open to applicants in Ohio, +4 more states.

📋 Description

• Enhance medication utilization for members facing complex health conditions or chronic illnesses while minimizing overall care expenses.

• Perform medication assessments, pinpoint drug therapy issues, and collaborate with healthcare providers and care managers on suitable interventions.

• Collaborate with care management, disease management, and interdisciplinary teams to facilitate medication optimization and achieve optimal health results.

• Aid in the creation and execution of care plans for members, particularly targeting high-risk or high-cost populations.

• Act as a subject matter authority on pharmacy benefits, encompassing formulary management, prior authorization, and step therapy protocols.

• Address pharmacy-related inquiries from healthcare providers, members, and internal departments to ensure clear communication and proper benefit usage.

• Support initiatives associated with HEDIS, CMS Star Ratings, and various quality performance metrics related to medication use.

• Identify and resolve care gaps through focused outreach and interventions.

• Provide education to providers regarding formulary updates, best prescribing practices, and opportunities for enhanced medication use.

• Conduct member outreach as necessary to promote medication understanding, adherence, and overall wellness.

• Ensure adherence to state and federal regulations governing pharmacy services, including Medicare Part D and Medicaid guidelines.

• Assist with reporting and documentation to facilitate audits, accreditations, and internal evaluations.

• Analyze pharmacy and medical claims data to uncover trends, risks, and improvement opportunities.

• Monitor and report on clinical outcomes, program effectiveness, and performance metrics.

• Engage in the design and implementation of pharmacy-related quality improvement initiatives and pilot projects.

• Contribute to the ongoing enhancement of pharmacy and care coordination services throughout the organization.

• Participate in relevant boards, committees, task forces, and organizational meetings, along with other assigned activities.

• Licensure in multiple states may be necessary based on changing business needs and regulatory requirements.

• Execute other related tasks and responsibilities as assigned.

⛳️ Requirements

• Must hold a current license as mandated by the state board where services will be delivered.

• A minimum of three (3) years of experience in a managed care, health plan, or population health setting.

• At least three (3) years of demonstrated experience with quality measurement programs, including HEDIS, Star Ratings, and regulations pertaining to Medicare Advantage and Medicaid.

• Three (3) years of clinical pharmacy practice experience.

• Completion of a Managed Care Residency, Ambulatory Care Residency, OR Board Certification in pharmacy specialties such as Board Certified Pharmacotherapy Specialist (BCPS), Board Certified Ambulatory Care Pharmacist (BCACP), or Board Certified Geriatric Pharmacy (BCGP).

• Extensive knowledge of Medicare Part D and Medicaid pharmacy benefits.

• Experience working with interdisciplinary care teams, case managers, and providers to optimize medication utilization.

• Background in Medication Therapy Management (MTM), with proficiency in using MTM platforms and tools.

• Proficient in electronic health record (EHR) systems, such as EPIC.

🏝️ Benefits

• Health insurance

• Retirement plans

• Paid time off

• Flexible work arrangements

• Professional development