Health Outcomes Pharmacist

WVU Medicine•Home Work - Monongalia County WV (Local), WV

2d•Remote

About The Position

The Health Outcomes Pharmacist is a vital member of Peak Health’s clinical and quality operations, responsible for optimizing medication use and improving health outcomes across the member population. This position supports care management and quality initiatives by providing clinical pharmacy expertise, conducting medication reviews, addressing pharmacy benefit inquiries, and identifying and resolving medication-related issues. Working closely with interdisciplinary care teams, providers, and internal stakeholders, the Health Outcomes Pharmacist helps ensure safe, effective, and evidence-based medication therapy, with a particular focus on members with chronic or complex conditions. The pharmacist supports regulatory and quality performance efforts, including HEDIS and Medicare Star Ratings, by promoting medication adherence, identifying gaps in care, and contributing to the evaluation of outcomes and interventions. The ideal candidate will bring a strong foundation in clinical pharmacotherapy, knowledge of Medicare and Medicaid pharmacy benefit regulations, and experience in managed care or population health. Success in this role requires analytical skills, attention to detail, and the ability to collaborate across departments to meet organizational goals related to quality, cost, and member experience.

Requirements

Must possess current license as required by state board where services will be provided: PA: Pharmacist license through the Pennsylvania State Board of Pharmacy MD: Pharmacist license through the Maryland Board of Pharmacy OH: Pharmacist license through the Ohio Board of Pharmacy WV: Pharmacist license through the West Virginia State Board of Pharmacy Remote Workers only: Must additionally hold current Pharmacist license issued by state of residence.
Three (3) years experience working in a managed care, health plan, or population health environment.
Three (3) years proven experience with quality measurement programs including HEDIS, Stars Ratings, and Medicare Advantage and Medicaid regulations.
Three (3) years in clinical pharmacy practice.
Ability to work under stressful working conditions.
Ability to handle and maintain confidential information.
Ability to work cooperatively as a team member with articulate oral and written communication and presentation skills.
Ability to work in a fast-paced and rapidly changing environment with attention to detail.
Ability to work proactively and independently to research and resolve complex issues.
Experience with regulatory and accreditation standards.
Ability to apply relevant laws, regulations, requirements, and policy standards.
Extensive working knowledge of Microsoft Office applications including Excel, Outlook, PowerPoint, Teams, electronic medical records, and MTM platforms.

Nice To Haves

Managed Care Residency, Ambulatory Care Residency, OR Board Certification in Pharmacy specialties such as Board Certified Pharmacotherapy Specialist (BCPS), Board Certified Ambulatory Care Pharmacist (BCACP), or Board Certified Geriatric Pharmacy (BCGP).
In-depth knowledge of Medicare Part D and Medicaid pharmacy benefits.
Experience collaborating with interdisciplinary care teams, case managers, and providers to optimize medication use.
Experience in Medication Therapy Management (MTM), proficiency in utilizing MTM platforms and tools.
Proficiency with electronic health records (EHR) systems, such as EPIC.

Responsibilities

Provide evidence-based clinical recommendations to optimize medication use for members with complex conditions or chronic diseases and reduce total cost of care.
Conduct medication reviews, identify drug therapy problems, and collaborate with providers and care managers on appropriate interventions.
Partner with care management, disease management, and interdisciplinary care teams to support medication optimization and achieve desired health outcomes.
Contribute to the development and implementation of member care plans, especially for high-risk or high-cost populations.
Serve as a subject matter expert for pharmacy benefits, including formulary, prior authorization, and step therapy protocols.
Respond to pharmacy-related inquiries from providers, members, and internal departments to ensure clarity and appropriate benefit utilization.
Support initiatives related to HEDIS, CMS Star Ratings, and other quality performance metrics involving medication use (e.g., adherence, statin use, MTM).
Identify and address gaps in care through targeted outreach and interventions.
Educate providers on formulary changes, prescribing best practices, and opportunities for improved medication utilization.
Conduct member outreach as needed to support medication understanding, adherence, and wellness.
Ensure compliance with state and federal regulations related to pharmacy services, including Medicare Part D and Medicaid guidelines.
Assist with reporting and documentation to support audits, accreditation, and internal reviews.
Analyze pharmacy and medical claims data to identify trends, risks, and opportunities for improvement.
Track and report on clinical outcomes, program impact, and performance benchmarks.
Participate in the design and execution of pharmacy-related quality improvement programs and pilot projects.
Contribute to the continuous improvement of pharmacy and care coordination services across the organization.
Engage in relevant boards, committees, task forces, and organizational meetings, as well as other designated activities.
Licensure in multiple states may be required, depending on evolving business needs and regulatory requirements.
Perform other related duties and responsibilities as assigned.