Population Health Management Pharmacist

Elevance Health•Denver, CO

12d•Hybrid

About The Position

The Population Health Management Pharmacist (Clinical Pharmacist) oversees clinical program quality and appropriate medication use for in-scope provider groups to support quality and cost goals. This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Requirements

Requires BA/BS in Pharmacy.
Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience; or any combination of education and experience, which would provide an equivalent background.
Requires a registered pharmacist.
Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh).
For associates working within Puerto Rico who are member or patient facing either in a clinical setting or in the Best Transportation unit, a current PR health certificate and a current PR Law 300 certificate are required for this position.
Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US, unless they are command-sanctioned activities.
For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Nice To Haves

PharmD preferred.
Experience in medication use quality improvement programs, analyzing pharmacy spend and trends, and Medicare Star Part D measures strongly preferred.
Experience working with Medicare and Commercial providers strongly preferred.
PBM or Managed Care experience highly preferred.
Proficiency with Microsoft Excel preferred.

Responsibilities

Researches and synthesizes detailed clinical data related to pharmaceuticals to assist contracted providers in achieving cost and quality goals.
Serves as a clinical resource to other pharmacists and contracted providers in areas such as prospective, inpatient, and retrospective DURs and clinical support for therapeutic interventions.
Prepares information for network physicians using data within provider tools including Excel.
Evaluate pharmacy quality program data and work with stakeholders to identify, prioritize, and implement strategies to optimize medication use and manage pharmacy spending effectively.
During practice-level discussions, act as a subject matter expert in pharmacy-related clinical measures for value-based care agreements.
Work to improve pharmacy quality by staying up to date on STAR and HEDIS measures.
Provider education to support clinical pharmacy measures and reduce pharmacy costs.
Build impactful relationships with providers to close the feedback loop between pharmacy and provider.
Act as a pharmacy SME to internal and leadership teams.