Clinical Pharmacy Specialist (Remote)- Care Management Team

UPMC•Pittsburgh, PA

1d•Remote

About The Position

UPMC Health Plan is hiring a full-time Clinical Pharmacy Specialist to support the Care Management team within the Pharmacy Services department. This is a remote, work-from-home position with a Monday through Friday schedule from 8:30 a.m. to 5:00 p.m. EST. The Clinical Pharmacy Specialist provides clinical pharmacy expertise in developing, implementing, and managing the pharmacy benefit. The specialist helps manage pharmacy utilization and member care in compliance with applicable state and federal regulations, NCQA standards, and the mission, policies, and procedures of UPMC Health Plan and its Pharmacy Department. The role requires professionalism and commitment to the organization’s goals and objectives. The Care Management Pharmacist manages and evaluates therapeutic drug interventions and clinical pharmacy programs to control pharmacy trend and improve quality measures. The position works with interdisciplinary care teams, supports utilization and formulary management, develops and conducts Drug Utilization Review (DUR) and Medication Therapy Management (MTM) activities, and creates and maintains clinical reporting programs. Additional duties include regulatory compliance, customer communication, provider education, mentoring students and assisting with residency precepting if applicable, and contributing to formularies and Pharmacy and Therapeutics Committee work.

Requirements

Bachelor of Science degree in Pharmacy and/or Doctor of Pharmacy (Pharm.D.) degree from an accredited U.S. School of Pharmacy.
Registration as a registered pharmacist (RPh) in the Commonwealth of Pennsylvania, or eligibility for licensure by examination or reciprocity.
Meet continuing education requirements for Pennsylvania pharmacist relicensure: a minimum of 30 hours of structured pharmaceutical education every two years.
Effective written and oral communication skills.
Strong analytical ability and organizational skills.
Computer literacy for pharmacy programming, word processing, and data management.
Demonstrate reliability, professionalism, independent functioning, teamwork, and confidentiality.

Nice To Haves

Experience in pharmacy benefit management, insurance, or managed care, and knowledge of therapeutic interventions and other cost-containment programs.
Care management experience, including a managed care residency, 1–3 years of managed care experience, or at least 3 years of direct patient pharmacy practice experience involving counseling and clinical services.

Responsibilities

Manage and evaluate therapeutic drug interventions and clinical pharmacy programs intended to control pharmacy trend and improve pharmacy quality measures.
Conduct member and provider interventions, evaluate program outcomes, and consider comprehensive research projects.
Interact regularly with interdisciplinary care teams to coordinate member care.
Contribute ideas and develop or improve clinical programs, utilization management, formulary management, provider education, therapeutic substitution, MTM/DUR, clinical edits, quality improvement initiatives, and operational efficiencies.
Implement approved new programs and improvements and consider their outcomes.
Develop and conduct Drug Utilization Review (DUR), Medication Therapy Management (MTM), and other integrated programs with medical management.
Create, develop, maintain, and enhance clinical reporting programs, including physician-specific reporting, alternative prescribing programs for utilization, and assigned client plans.
Participate in assigned internal and external meetings, committees, and work groups.
Maintain understanding of Pennsylvania Department of Health, DPW, CMS, and NCQA requirements relevant to pharmacy operations, and ensure clinical functions comply with regulatory and accreditation requirements.
Maintain collaborative relationships with internal and external customers and communicate pharmacy information to members, employer groups, and providers.
Develop provider communications regarding formulary changes and adherence, health education, medication compliance, and trend management.
Mentor students and assist with precepting for the residency program, if applicable.
Work with employer clients, account management, and sales in assigned meetings to improve understanding of the pharmacy benefit and offer recommendations.
Develop and revise formularies for each line of business, including communications, department training, brochure and website updates, and submission of change forms.
Review new drugs in a timely manner and submit change forms as appropriate.
Research and prepare for Pharmacy and Therapeutics Committee meetings, ensuring recommendations on new drugs and policies are appropriate and discussed with subject matter experts.
Present assignments succinctly and at an appropriate pace, and answer relevant questions.
Function independently while supporting the team, complete designated workload and follow-up reliably and on time, maintain a professional image, and protect client and patient confidentiality.