Health Outcomes Pharmacist – DSNP

Jobtailor; Deutschland; Remote; EUR 95.000 - 121.000; Vollzeit

Zusammenfassung

Jobtailor is seeking a clinical pharmacist to provide evidence-based, outcome-driven medication optimization for members with complex conditions. You will conduct reviews, identify therapy gaps, and collaborate with care managers to improve health outcomes.

The role requires licensure in relevant states, experience in managed care, and strong knowledge of formulary and MTM platforms, supporting CMS Star Ratings and Medicare/Medicaid guidelines.

Qualifikationen

• Active pharmacist license required
• 3+ years in managed care, health plan, or population health
• Experience with quality measurement programs (HEDIS, Star Ratings) a plus

Aufgaben

• Provide evidence-based clinical recommendations to optimize medication use for members with complex conditions
• Conduct medication reviews and identify drug therapy problems with care team collaboration
• Partner with care management and interdisciplinary teams to support medication optimization and outcomes
• Contribute to care plans for high-risk populations
• Serve as subject matter expert on formulary, prior authorization, and step therapy protocols
• Respond to pharmacy inquiries from providers and members
• Support HEDIS, CMS Star Ratings, and related quality initiatives
• Analyze claims data to identify trends and improvement opportunities
• Track clinical outcomes and program impact
• Participate in pharmacy quality improvement programs and committees

Kenntnisse

Medication Reviews

Drug Therapy Problem Identification

Clinical Outcome Tracking

Pharmacy Claims Data Analysis

Care Plan Contribution

Articulate Communication

Attention to Detail

Independent Problem Solving

Ausbildung

Current Pharmacist License

Managed Care Residency

Ambulatory Care Residency

BCPS

BCACP

BCGP

Tools

Microsoft Office

Electronic Medical Records

MTM Platforms

EHR Systems

Jobbeschreibung

• Provide evidence-based clinical recommendations to optimize medication use for members with complex or chronic conditions
• Conduct medication reviews, identify drug therapy problems, and collaborate with providers and care managers on interventions
• Partner with care management, disease management, and interdisciplinary teams to support medication optimization and health outcomes
• Contribute to care plans for high-risk or high-cost populations
• Serve as a subject matter expert on formulary, prior authorization, and step therapy protocols
• Respond to pharmacy inquiries from providers, members, and internal departments
• Support HEDIS, CMS Star Ratings, and medication-related quality initiatives
• Identify and address gaps in care through outreach and interventions
• Educate providers on formulary changes and prescribing best practices
• Conduct member outreach supporting medication understanding, adherence, and wellness
• Ensure compliance with state and federal pharmacy regulations, including Medicare Part D and Medicaid guidelines
• Assist with reporting and documentation for audits, accreditation, and internal reviews
• Analyze pharmacy and medical claims data to identify trends, risks, and improvement opportunities
• Track and report clinical outcomes, program impact, and performance benchmarks
• Participate in pharmacy quality improvement programs and pilot projects
• Contribute to continuous improvement of pharmacy and care coordination services
• Participate in boards, committees, task forces, and organizational meetings
• Perform other related duties as assigned

Requirements

• Current pharmacist license through the applicable state board (Pennsylvania, Maryland, Ohio, or West Virginia)
• Remote workers must additionally hold a current pharmacist license issued by their state of residence
• Three years of experience in a managed care, health plan, or population health environment
• Three years of experience with quality measurement programs including HEDIS, Star Ratings, Medicare Advantage, and Medicaid regulations
• Three years of clinical pharmacy practice
• Ability to handle confidential information
• Articulate oral and written communication and presentation skills
• Ability to work in a fast-paced, rapidly changing environment with attention to detail
• Ability to research and resolve complex issues independently
• Experience with regulatory and accreditation standards
• Ability to apply relevant laws, regulations, requirements, and policy standards
• Working knowledge of Microsoft Office applications including Excel, Outlook, PowerPoint, Teams, electronic medical records, and MTM platforms
• Ability to stand and walk short distances for eight or more hours
• Frequent bending, stooping, or stretching
• Ability to lift 30 pounds and push 50 pounds
• Preferred: Managed Care Residency, Ambulatory Care Residency, or board certification such as BCPS, BCACP, or BCGP
• Preferred: In-depth knowledge of Medicare Part D and Medicaid pharmacy benefits
• Preferred: Experience collaborating with interdisciplinary care teams, case managers, and providers
• Preferred: Experience with Medication Therapy Management and MTM platforms
• Preferred: Proficiency with EHR systems such as EPIC

Core Competencies

Demonstrates expertise in clinical pharmacy practice, medication optimization, and quality measurement programs, with a strong focus on HEDIS and CMS Star Ratings. Proficient in collaborating with interdisciplinary teams and ensuring compliance with pharmacy regulations.

Highest-signal resume keywords

• Current Pharmacist License
• Clinical Pharmacy Practice
• Quality Measurement Programs
• Medication Therapy Management
• Regulatory Compliance

ATS Optimization Keywords

Hard Skills

• Medication Reviews
• Drug Therapy Problem Identification
• Clinical Outcome Tracking
• Pharmacy Claims Data Analysis
• Care Plan Contribution

Soft Skills

• Articulate Communication
• Attention to Detail
• Independent Problem Solving

Certifications & Qualifications

• Managed Care Residency
• Ambulatory Care Residency
• BCPS
• BCACP
• BCGP

Industry Keywords

• HEDIS
• CMS Star Ratings
• Medicare Part D
• Medicaid Guidelines
• Pharmacy Quality Improvement

Tools & Technologies

• Microsoft Office
• Electronic Medical Records
• MTM Platforms
• EHR Systems