Pharmacy Services Specialist, Health Plans (Pharmacist)

VNS Health-posted about 2 months ago
$98,200 - $130,800/Yr
Full-time • Mid Level
Manhattan, NY
Nursing and Residential Care Facilities
Resume
Match Score
Upload and Match ResumeTrack Jobs with Teal

Provides technical, analytic and clinical support related to the management of VNS Health Plans's pharmaceutical programs across all business lines. Resolves problems regarding Pharmacy Benefit Manager (PBM) clinical pharmaceutical services. Serves as a clinical pharmacy resource for clinical staff with medication management questions or pharmaceutical problems. Works under general supervision.

  • Assists with the preparation of pharmacy data reports and analysis that meets the planning, clinical, quality, and regulatory needs of the corporate entity and all lines of business, working with the Medical Management, Data Management, Finance Departments and clinical operations.
  • Participates in the decision making process for Prior Authorization and appeals processes related to pharmacy claims.
  • Participates in multidisciplinary clinical rounds by working up members' medications for potential medication related issues and serve as medication management expert for other members of the team.
  • Participates in reviewing denied pharmacy claims for appropriateness of rejection and point-of-sale messaging.
  • Leads member experience initiatives related to denied pharmacy claims to facilitate access to drugs.
  • Responds to, researches and resolves any problems related to member complaints regarding Pharmacy Benefit Manager (PBM) clinical pharmaceutical services.
  • Participates in Quality Improvement projects; Utilization Review; Individual Drug Profile Review; and Pharmacy Standard and Protocol Development.
  • Serves as a clinical pharmacy resource for clinical staff with medication management questions or pharmaceutical problems, interacting with physicians when required.
  • Assists Pharmacy Services Manager in the development, provision and maintenance of drug research resources and other educational materials related to pharmaceutical management.
  • Assists with the administration of Medication Management Programs, working collaboratively with other team members.
  • Delivers pharmacy related education and training including new employee orientation.
  • Collaborates with Manager to help VNS Health Plans achieve goals in pharmacy related Stars targets.
  • Participates in special projects and performs other duties as assigned.
  • Licensed and registered in New York State to Practice as a Registered Pharmacist required
  • Doctorate in Pharmacy (PharmD) required
  • Minimum of two years of pharmacy experience required
  • Experience in Medicare Part D regulations and NY State regulations for Medicaid preferred
  • Experience in a managed care and/or clinical care setting and geriatric pharmacy management, including experience in developing and providing professional and patient educational programs in pharmaceutical care preferred
  • Experience in the use and analysis of pharmaceutical data and databases preferred
  • Ability to use software and knowledge of Microsoft Word, Excel and Power Point required
  • Referral bonus opportunities
  • Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
  • Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
  • Employer-matched retirement saving funds
  • Personal and financial wellness programs
  • Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
  • Generous tuition reimbursement for qualifying degrees
  • Opportunities for professional growth and career advancement
  • Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
Track Jobs with Teal

Job Search Resources

•
Resume Builder
•
Resume Examples
•
Cover Letter Examples

Tools

Career Hubs

Guides

Company

© 2024 Teal Labs, Inc
Privacy PolicyTerms of Service