Clinical Pharmacist

Healthfirst; Tennessee; On-site; USD 89,000 - 132,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Life insurance

401k contributions

Job summary

Healthfirst is seeking a Clinical Pharmacist to support quality measures for Essential Plan and Medicare populations. You will perform provider and member outreach to address gaps in care, support medication adherence, and help develop strategies to improve quality measures while remaining compliant with federal and state regulations.

You will precept residents and students, review data trends, and collaborate with Marketing, IT, and Enterprise Analytics to create effective digital outreach.

Qualifications

• Pharmacy degree from an accredited school of pharmacy.
• Registered Pharmacist, with a state license in good standing.
• Strong written and verbal clinical communication.
• Knowledge of specialty pharmaceuticals and billing practices in medical and pharmacy benefits.

Responsibilities

• Support initiatives to resolve gaps in care through provider and member outreach.
• Ensure recommendations align with latest guidelines and evidence.
• Provide clinical pharmacy support to pharmacy technicians during member outreaches.
• Collaborate with Marketing, IT, and Analytics for digital member outreach channels.
• Identify and resolve same-day member grievances promptly.
• Oversee compliance with state and federal agencies.
• Precept Pharmacy Residents and Students.
• Ensure clinical criteria comply with CMS and NYSDOH.
• Research drug information to maintain knowledge and disease state understanding.
• Review monthly reports and provide feedback on trends and efficiency.

Skills

Clinical communication

Pharmacy knowledge

Regulatory compliance

Bilingual capability

Education

Doctor of Pharmacy (PharmD)

Tools

Microsoft Outlook

Microsoft Word

Microsoft PowerPoint

Microsoft Excel

Job description

The Clinical Pharmacist is responsible for efforts to support quality measures for both our Essential Plan and Medicare populations. The Clinical Pharmacist conducts provider and member outreach to address gaps in care measures, support medication adherence initiatives, and assist with strategies to improve quality measures, all while maintaining compliance with all Federal and State agencies. This is a dynamic position requiring the Clinical Pharmacist to stay current with literature, evidence-based medicine, and trends in medicine.

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

Hiring Range*

• Greater New York City Area (NY, NJ, CT residents): $103,400 - $149,430
• All Other Locations (within approved locations): $88,700 - $131,920

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

• The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.