Clinical Pharmacy Specialist (Hybrid)- Pittsburgh, PA (Must be licensed in PA)

UPMC•Pittsburgh, PA

7h•Hybrid

About The Position

UPMC Health Plan has an exciting opportunity for a Clinical Pharmacy Specialist in the Pharmacy Services department. This is primarily a work-from-home position but may require coming into the office, which is located in downtown Pittsburgh, various times throughout the year. Working hours are Monday through Friday 8:30 a.m. to 5:00 p.m. Registration as a registered pharmacist (RPh), in the Commonwealth of Pennsylvania or eligibility for licensure by examination or reciprocity is required. This job provides clinical pharmacy expertise to develop, implement, and manage the pharmacy benefit. The Clinical Pharmacist assists in managing pharmacy utilization and provides expertise in managing member care. These services will be provided in compliance with state and federal regulations, NCQA standards, the mission, policies, and procedures of the Health Plan and Pharmacy Department. The individual should demonstrate professionalism and commitment to meeting UPMCHP goals and objectives.

Requirements

Registration as a registered pharmacist (RPh), in the Commonwealth of Pennsylvania or eligibility for licensure by examination or reciprocity.
Bachelor of Science Degree in Pharmacy, and/or Doctor of Pharmacy Degree (Pharm.D.) from an accredited U.S. School of Pharmacy.
Effective communication skills, both written and oral.
Strong analytical ability and organizational skills.
Computer literacy for pharmacy programming, word processing, and data management.
Continuing Education requirements met each bi-annual cycle for re-licensure, as evident by obtaining a minimum of 30 hours of continuing education every 2 years in structured pharmaceutical education as necessary by the state board.
Act 34 clearance.

Nice To Haves

Experience in pharmacy benefit management, insurance, and managed care.
Knowledgeable in therapeutic interventions and other cost containment programs.
Managed care residency or 1-3 years of managed care experience in formulary development and management, especially in Medicare, Medicaid, Commercial and/or Exchange lines of business.

Responsibilities

Demonstrate multiple years of being a consistent, high-performing team member as measured by both volume and quality of work performed.
Demonstrate initiative and ability to work independently.
Manage ongoing responsibilities from completed stretch projects, including training other staff, actively participating and contributing solutions in strategic discussions, assisting with internal and external audits, and creating and assisting with workflow improvement and efficiency initiatives.
Assist in finding new clinical, quality, and efficiency improvements through the management of the Formulary, Prior Authorization, and other clinical programs.
Responsible for the successful and satisfactory completion of additional projects that are beyond their day-to-day tasks.
Assisting with clinical management of the designated line of business (Commercial, Exchange, Medicare, Medicaid, Exchange, and/or CHIP) from a pharmacy formulary and operational perspective.
Understanding and complying with rules and regulations affecting the business.
Develop and revise various formularies for each line of business including sending communications, training of identified departments, updating all brochures, updating appropriate websites, and submitting change forms.
Review new drugs promptly and submit change forms as appropriate.
Research adequately and be properly prepared for all P&T Committee meetings, ensuring all recommendations for both new drugs and new policies are appropriate and have been discussed with subject matter experts.
Present these assignments succinctly and at a suitable pace and answer relevant questions.
Provide innovative ideas for new and existing clinical program development, utilization management, formulary management, provider education, and therapeutic substitution programs.
Work with employer clients, account management, and sales in meetings as assigned to improve the understanding of the pharmacy benefit, as well as offering recommendations.
Participate in meetings, committees, and work groups both internally and externally as assigned.
Maintain a solid understanding of the requirements of the Pennsylvania Department of Health, DPW, CMS, and the National Committee for Quality Assurance, specifically as they relate to the expectations of pharmacy operations.
Ensure compliance with regulatory and accreditation requirements of clinical functions.
Foster and maintain collaborative relationships with internal and external customers.
Communicate pharmacy information as appropriate to members, employer groups, and providers.
Develop communication materials to providers, including discussions regarding formulary changes/adherence, health education, medication compliance, and trend management.
Mentor students and assist in precepting for the residency program if applicable.
Assists in the training of pharmacy personnel.