Job Details

Duties & Responsibilities:

• Support initiatives to resolve gaps in care through direct provider and member outreach, collaboration with provider engagement, and leveraging our pharmacy network capabilities

• Ensure that all recommendations are consistent with the latest guidelines or otherwise supported by the clinical compendia

• Provide clinical pharmacy support to pharmacy technicians as they conduct outreaches to members regarding med adherence, resolve existing barriers to adherence, and use motivational interviewing to improve the health of our members

• Collaborate internally with Marketing, IT, and Enterprise Analytics to assist with the creation of strategic digital communication channels for member outreach

• Identify and resolve same-day grievances reported by members in a timely manner consistent with our policies and procedures

• Oversee and maintain compliance with all State and Federal agencies

• Precept Pharmacy Residents and Students

• Ensure all clinical criteria is in compliance with Center of Medicare and Medicaid Services (CMS) and the New York State Department of Health (NYSDOH)

• Research drug information to maintain drug knowledge and disease state understanding

• Review monthly reports and provide feedback on trends, ideas for efficiency, and innovation

• Additional duties as assigned or required

Minimum Qualifications:

• Pharmacy degree from an accredited school of pharmacy

• Registered Pharmacist, with a state license in good standing

• Work experience requiring written and verbal clinical communication that is clear, concise, grammatically correct, and professional

• Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefits

Preferred Qualifications:

• Bilingual in English and one or more language(s): Spanish, Mandarin, Cantonese may be required based on business needs

• Ability to work well in a team environment and be a team player

• Demonstrated critical thinking and problem-solving skills

• Passion for learning, promoting the profession of pharmacy, and interest in growing skills in a dynamic environment with various opportunities

• Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local Coverage Determinations

• Ability to lead large and small working meetings

• PC Skills with Microsoft Outlook, Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables)

Compliance & Regulatory Responsibilities: Assists in regulatory and compliance audits for all plans. Ensure all activities are conducted in compliance with regulations.

License/Certification: Licensed pharmacist in good standing

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.