Personal Care Pharmacist

Univera Healthcare•Rochester, NY

10d•$87,766 - $157,978•Hybrid

About The Position

This position supports the health plan’s Personal Care Pharmacy Team by addressing the medication needs of members with multiple chronic conditions and open clinical gaps. In collaboration with departments such as Quality Management, Customer Care, and Care Management, the Personal Care Pharmacist conducts telephonic outreach to optimize disease state management and drive gap closure.

Requirements

Current New York State Pharmacist license with a PharmD or Bachelor of Science in Pharmacy
At least two years of experience in a healthcare or retail setting, with a focus on clinical services, patient care, or care management activities or completion of a PGY-1 residency.
Strong interpersonal, consultative, and communication skills, including experience engaging members, patients, and healthcare professionals.
Ability to manage multiple priorities in a fast-paced environment while maintaining accuracy and attention to detail.
Demonstrated ability to perform comprehensive drug regimen reviews and maintain current clinical knowledge.
Maintains confidentiality and uses only the minimum necessary protected health information (PHI) to accomplish job responsibilities.
Strong computer skills, including proficiency in Microsoft Word, Excel, Outlook, and PowerPoint, and the ability to learn new systems.
Minimum of three years of experience in an organized healthcare setting with strong clinical pharmacy knowledge required; at least one year must include direct patient and provider outreach (in person or telephonic).
Demonstrated experience developing or supporting managed care pharmacy programs with measurable clinical impact.
Innovative thinking and effective communication related to clinical decision-making and pharmacy case management strategies.
Ability to analyze claims data and member trends to identify gaps and propose new initiatives.
Experience working with complex populations, including members with both physical and behavioral health needs.
Minimum of five years of experience in an organized healthcare setting with strong clinical pharmacy knowledge required.
In lieu of experience, completion of a managed care or ambulatory care residency program with at least two additional years of experience is acceptable.
Demonstrated ability to quantify program outcomes, including clinical impact, utilization, cost, and member experience.
Advanced business acumen supporting strategic decision-making, program prioritization, and resource allocation.
Advanced understanding of organizational pharmacy and quality strategies, with the ability to identify and implement aligned improvement initiatives.
Advanced knowledge of CMS requirements and standards related to pharmacy and non-pharmacy quality measures.
Demonstrated leadership and ability to serve as a role model within the department.

Responsibilities

Evaluate medication-related problems such as adverse events, therapeutic duplication, adherence issues, polypharmacy, and untreated conditions.
Utilize prescription and medical claims data to develop clinical recommendations that address member-specific barriers and gaps in care.
Document, analyze, and report outreach activities, interventions, and outcomes when available.
Provide member education and materials on the appropriate use of medications.
Resolve member-specific benefit issues and refer to appropriate teams as needed.
Apply formulary and benefit information to guide appropriate medication recommendations and reduce access barriers.
Provide disease-specific education and self-management resources based on established protocols.
Collaborate in a matrixed environment with departments including Health Care Improvement, Provider Relations, Customer Care, and Pharmacy Operations.
Maintain knowledge of regulatory and CMS program requirements, including the CMS STARs program.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Regular and reliable attendance is expected and required.
Performs other functions as assigned by management.
Collaborate with cross-functional teams to design and implement strategies addressing complex chronic disease populations.
Monitor the drug pipeline and proactively identify potential affordability, access, or utilization barriers impacting care.
Partner with Quality Management to develop targeted outreach strategies for high-impact populations.
Partner with Clinical Strategy, Pharmacy Quality, Quality Improvement, and Analytics teams to improve outreach efficiency and effectiveness.
Develop and maintain desk-level procedures for outreach, documentation, and outcome measurement.
Present program outcomes and strategic recommendations to leadership.
Partner with stakeholders to define program metrics, quantify outcomes, and articulate program value.
Standardize tools, processes, and best practices to ensure consistency and scalability.
Provide mentorship and training to Personal Care Clinical Pharmacist I and II staff.
Represent the health plan, as appropriate, in regional or national quality improvement forums or collaborative initiatives.
Serve as a subject matter expert to leadership on pharmacy-related program performance, trends, risks, and opportunities.
Lead cross-functional initiatives to improve gap closure and align with enterprise programs.