Clinical Pharmacy Specialist, Pharmacy Benefits Manager (VIVO Health)

Northwell Health•New Hyde Park, NY

51d

About The Position

The Clinical Pharmacy Specialist is responsible for the development, implementation, and maintenance of drug formularies, clinical utilization management (UM) criteria, and evidence-based drug therapy guidelines, and overseeing pharmacy benefit claims adjudication to match formulary intent. This role involves critical evaluation of clinical literature, pharmacoeconomic data, and regulatory requirements to support P&T Committee decisions and ensure cost-effective, high-quality pharmaceutical care for plan members.

Requirements

Bachelor of Pharmacy with 1 year internship required, or equivalent combination of education and related experience.
Current License to practice as a Pharmacist in New York State required, plus specialized certifications as needed.
1-3 years of technical experience, required.

Nice To Haves

Doctor of Pharmacy (PharmD) degree from an accredited College of Pharmacy is essential.
PGY1 or PGY2 Preferred
5+ years of clinical pharmacy experience post-licensure, with a significant portion (4+ years) directly in a managed care organization, Pharmacy benefit manager, or health plans
Experience in formulary management, P&T committee support, and/or utilization management (PA, ST, QL) criteria development
Experience with benefit design, claims data analysis, and drug information interpretation.

Responsibilities

Develops and monitors the hospital's policies/procedures regarding utilization of medications in collaboration with the medical staff, Pharmacy, and Therapeutics Committee; monitors medication utilization effectively and intervenes when necessary to ensure compliance.
Monitors pharmacists activities regarding utilization surveillance and provides instruction/education as necessary; maintains necessary and appropriate records regarding the effectiveness of these drug therapy regimens and provides information as required.
Ensures the safe and effective use of medication; guides staff in the provision of clinical services.
Provides necessary, requested information to management for consideration in the staff's performance appraisals; collaboratively, coordinates/implements educational training and competency programs for the staff and pharmacy students.
Provides educational programs for health care staff regarding medication use; provides training as measured by the success of the staff to accomplish identified goals and improve patient care; incorporates professional concerns into the program.
Coordinates activities with the assigned student preceptor and monitors the student's activities and evaluates performance; initiates and implements programs.
Coordinates and participates in the development of the hospital's Formulary and related activities; contributes to the Formulary review process.
Initiates/coordinates MUEs for P&T presentation; discusses findings.
Performs all duties of a licensed registered Pharmacist as required by the leadership and as identified by the ability of the department to effectively provide comprehensive service; maintains compliance with established procedures, policies, and laws in performing the duties of a licensed, registered staff pharmacist.
Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related are not essential functions.