Senior Pharmacist
Company: Highmark Health
Location: Columbia
Posted on: May 28, 2023
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Job Description:
Company :
Highmark Inc.
Job Description :
JOB SUMMARY
This job works in a team oriented environment monitoring
FDA-approvals, drug manufacturer pipelines, and assess drug
utilization reports, in order to develop and execute the the
Organization's Drug Formulary, and/or recommend codes for
pharmaceutical based reporting. The incumbent may write drug
monographs for Committee review; develops and implements the
Organization's management programs including but not limited to:
prior authorization, dose and duration edits, quantity limits,
step-care edits, generic sampling, pharmacy policy review and
development and/or review of member specific information to improve
individual outcomes as an adjunct to health coaching. If acting in
the capacity as a clinical pharmacist the incumbent may also review
UM requests; provide consultation into the case and disease
management identification process, and consult with the
Organization's Associate Medical Directors and Medical Directors
when appropriate, follow-up on appeals in accordance with our
regulatory guidelines. The incumbent develops and implements
physician, pharmacy, account, and member educational initiatives
that promote the Organization's Formularies, utilization management
programs, and case/ disease management initiatives; providing
clinical review and decisions for physician and member appeals and
participates on cross-functional committees to develop and
implement clinical and operational initiatives.
ESSENTIAL RESPONSIBILITIES
Monitor FDA-approvals, drug manufacturer pipelines, assess drug
utilization reports, and write drug monographs for Committee review
to develop the Organization's Drug formulary and/OR provide
recommendations for NDC code capture, and monthly identification of
high risk members.
Gateway - Assist in the development of Gateway's Drug Formularies
by monitoring FDA-approvals and drug manufacturer pipelines,
assessing drug utilization reports, and writing drug monographs for
Pharmacy & Therapeutics Committee review.
Assist in the development and implementation of utilization
management programs including but not limited to: prior
authorization, dose and duration edits, quantity limits, step-care
edits, generic sampling medical policy review and development,
member facing outreach initiatives
Develop and implement physician, pharmacy, account, and member
educational initiatives that promote the Organization's
Formularies, utilization management programs, and disease
management initiatives.
Provide clinical review and decisions including but not limited to:
physician and member appeals, member or provider
information/education.
Participate on cross-functional committees to develop and implement
clinical and operational initiatives within Integrated Clinical
Services. May participate in outreach efforts as needed to
effectively reach goals of Medication Therapy Management programs
to include, but not limited to Comprehensive Medication Reviews and
Targeted Medication Reviews.
Identify and assist in managing department process improvements to
maximize overall efficiencies.
Manage individual projects for timely review with the Director,
Clinical Pharmacy.
Participate in Medicare Stars performance measures to drive
contribution to excellence (5 Stars).
Other duties as assigned or requested.
QUALIFICATIONS
Required
Bachelor of Science in Pharmacy with experience in clinical /
formulary management or a Doctor of Pharmacy degree with experience
in clinical formulary management
5 years of related, progressive experience int he area of
specialization
An understanding of managed care principles and practices is
essential
Demonstration of strong verbal and written communication skills, as
well as, proficiency in the use of computer-based data
processing
Microsoft Office products, and database applications
Preferred
SKILLS
Be able to quickly identify and prioritize essential elements of
problem
Independently or in a team, be able to identify the root issues and
formulate potential solutions
Accurately use logic and reasoning in identifying alternate
solutions, conclusions or approaches to problems. Potential
solutions should be synthesized into presentation, timetable to
resolution and appropriate follow up with measurable outcomes
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from
site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales
employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the
general nature and essential duties and responsibilities of work
performed by employees within this job title. It may not contain a
comprehensive inventory of all duties, responsibilities, and
qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal
standards and behavioral expectations as set forth in the code of
business conduct and company policies.
As a component of job responsibilities, employees may have access
to covered information, cardholder data, or other confidential
customer information that must be protected at all times. In
connection with this, all employees must comply with both the
Health Insurance Portability Accountability Act of 1996 (HIPAA) as
described in the Notice of Privacy Practices and Privacy Policies
and Procedures as well as all data security guidelines established
within the Company's Handbook of Privacy Policies and Practices and
Information Security Policy.
Furthermore, it is every employee's responsibility to comply with
the company's Code of Business Conduct. This includes but is not
limited to adherence to applicable federal and state laws, rules,
and regulations as well as company policies and training
requirements.
Pay Range Minimum:
$78,900.00
Pay Range Maximum:
$146,000.00
Base pay is determined by a variety of factors including a
candidate's qualifications, experience, and expected contributions,
as well as internal peer equity, market, and business
considerations. The displayed salary range does not reflect any
geographic differential Highmark may apply for certain locations
based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against
qualified individuals based on their status as protected veterans
or individuals with disabilities, and prohibit discrimination
against all individuals based on their race, color, age, religion,
sex, national origin, sexual orientation/gender identity or any
other category protected by applicable federal, state or local law.
Highmark Health and its affiliates take affirmative action to
employ and advance in employment individuals without regard to
race, color, age, religion, sex, national origin, sexual
orientation/gender identity, protected veteran status or
disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected
Veterans/Disabled/Sexual Orientation/Gender Identity (
https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf
)
We endeavor to make this site accessible to any and all users. If
you would like to contact us regarding the accessibility of our
website or need assistance completing the application process,
please contact number below.
For accommodation requests, please contact HR Services Online at
HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and
Applicants Notice
Req ID: J224044
Keywords: Highmark Health, Columbia , Senior Pharmacist, Healthcare , Columbia, South Carolina
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