Health Plan Clinical Pharmacist

This is a fully remote position, open to applicants in Maine.

📋 Description

• Develop and execute clinical pharmacy strategies aimed at delivering high-quality, cost-efficient pharmacy management and outcomes.

• Identify and create evidence-based pharmaceutical utilization cost-saving programs and initiatives.

• Oversee and support pharmacy-related quality metrics, including Medicare Star Ratings and HEDIS.

• Collaborate with quality and population health teams to pinpoint medication-related care gaps and facilitate interventions.

• Act as a drug information specialist for the mail order pharmacy, health plan team members, and associated practices.

• Assist in the development and upkeep of the Health Plan Drug Formulary.

• Coordinate and engage in drug prior authorizations and other pharmacy utilization management activities.

• Create and distribute educational materials, newsletters, and talking points for members/providers.

• Pursue ongoing professional development while identifying industry trends, best practices, and innovative solutions.

• Support staff with drug information, clinical initiatives, benefit design and interpretation, claims processing issues, and marketing assistance.

• Ensure that pharmacy and PBM systems accurately reflect benefit and drug coverage.

• Assist in resolving claims adjudication issues that require clinical expertise.

• Participate in activities that ensure compliance with Department of Defense and Medicare Part D regulations.

• Develop and update policies, procedures, and protocols as necessary.

• Exemplify the organization’s mission, vision, and core values.

⛳️ Requirements

• Pharm.D. or BS in Pharmacy with pertinent clinical experience.

• Current license or eligibility for licensure to practice pharmacy in ME; license must be unrestricted to perform UM functions.

• A minimum of 3 years of experience in retail, hospital, or managed care pharmacy settings.

• In-depth knowledge of drug products, medical therapeutics, pharmacokinetics, and various disease states.

• Familiarity with PBM third-party billing, pharmacy claims processing, and pharmacy data management.

• Excellent customer service capabilities.

• Outstanding written and verbal communication skills.

• Proficient in Microsoft Office applications (Word, Excel, PowerPoint).

• Strong organizational skills with the ability to prioritize and multitask effectively.

• Strong interpersonal skills and capability to collaborate with both internal and external clients.

• Solid mathematical aptitude.

• Comprehensive clinical knowledge of therapeutic drug utilization.

• Ability to operate independently with sound judgment in decision-making.

• Capability to take appropriate initiative while seeking input/advice when necessary.

• Ability to manage confidential and sensitive information with discretion and professionalism.

• Proven ability to review and analyze data effectively.

• Must not require immigration sponsorship.

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Retirement savings with employer contributions.

• Paid time off.

• Volunteer time off.

• Pie day.

• Additional employee benefits.

• Potential eligibility for incentive or commission-based programs, subject to plan terms.