Clinical Pharmacist – PBM

Jobtailor

Harrisburg (Dauphin County)

On-site

USD 140,000 - 180,000

Full time

14 days+

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Job summary

Jobtailor in Harrisburg, PA seeks a Pharmacy leadership professional to develop and manage clinical initiatives, and to oversee formulary and utilization management programs. The role includes supervising staff and coordinating with PBMs and committees to ensure regulatory compliance.

Ideal candidates have a pharmacy degree, PA license, and experience in protocol development, cost containment, and Medicare Part D oversight.

Qualifications

Pharmacy degree required.
Current Pennsylvania pharmacy license required.
Experience developing pharmacy clinical protocols, policies, and procedures.
Experience designing and deploying programs to increase quality of care and decrease costs.
In-depth knowledge of drug formulary systems and drug evaluation processes.
Broad knowledge of outpatient drug benefits and utilization management programs.
Knowledge of pharmacy claims processing and applicable state/federal laws.
Knowledge and experience with therapy medication and disease state management.
Working knowledge of medical and pharmacy data integration.
Strong clinical/analytical skills and decision-making capabilities.
Strong interpersonal, teamwork, and communication skills.
Ability to lead meetings and deliver verbal presentations.
Ability to work with minimal supervision.
Ability to assess utilization data.
Advanced pharmacy degree (Master's or Pharm.D.) preferred.
Managed care knowledge and experience preferred.
Medicare Part D and NCQA accreditation knowledge and experience preferred.

Responsibilities

Develop, maintain, and evaluate pharmacy clinical initiatives and utilization management programs.
Manage the drug formulary program, including drug evaluation and Pharmacy and Therapeutics Committee activities.
Oversee clinical program administration by the pharmacy benefit management company.
Manage pharmaceutical utilization and trends through pharmacy clinical initiatives.
Oversee PBM vendor clinical services and programs.
Manage specialty pharmaceuticals.
Develop pharmacy clinical and utilization management criteria, protocols, policies, and procedures.
Provide clinical and drug information support.
Maintain Medicare Part D, regulatory, and accreditation compliance.
Develop member and provider educational programs.
Conduct presentations and training.
Maintain provider and pharmaceutical industry/drug manufacturer relations.
Provide clinical support to Pharmacy and Therapeutics, Medical Policy, Quality Management, Delegation Oversight, and HEDIS/NCQA committees and workgroups.
Supervise staff.
Perform other related duties and assignments as directed.
Travel less than 1%, including occasional overnight travel and travel between Capital Blue Cross locations.

Skills

Interpersonal Skills

Teamwork

Communication Skills

Presentation Skills

Leadership

Education

Pharmacy Degree

Current Pennsylvania Pharmacy License

Advanced Pharmacy Degree

Tools

Pharmacy Benefit Management Systems

Pharmacy and Therapeutics Committee Tools

Utilization Data Assessment Tools

Job description

Develop, maintain, and evaluate pharmacy clinical initiatives and utilization management programs
Manage the drug formulary program, including drug evaluation and Pharmacy and Therapeutics Committee activities
Oversee clinical program administration by the pharmacy benefit management company
Manage pharmaceutical utilization and trends through pharmacy clinical initiatives
Oversee PBM vendor clinical services and programs
Manage specialty pharmaceuticals
Develop pharmacy clinical and utilization management criteria, protocols, policies, and procedures
Provide clinical and drug information support
Maintain Medicare Part D, regulatory, and accreditation compliance
Develop member and provider educational programs
Conduct presentations and training
Maintain provider and pharmaceutical industry/drug manufacturer relations
Provide clinical support to Pharmacy and Therapeutics, Medical Policy, Quality Management, Delegation Oversight, and HEDIS/NCQA committees and workgroups
Supervise staff
Perform other related duties and assignments as directed
Travel less than 1%, including occasional overnight travel and travel between Capital Blue Cross locations

Requirements

Pharmacy degree required
Current Pennsylvania pharmacy license required
Experience developing pharmacy clinical protocols, policies, and procedures
Experience designing and deploying programs to increase quality of care and decrease costs
In-depth knowledge of drug formulary systems and drug evaluation processes
Broad knowledge of outpatient drug benefits and utilization management programs
Knowledge of pharmacy claims processing and applicable state/federal laws
Knowledge and experience with therapy medication and disease state management
Working knowledge of medical and pharmacy data integration
Strong clinical/analytical skills and decision-making capabilities
Strong interpersonal, teamwork, and communication skills
Ability to lead meetings and deliver verbal presentations
Ability to work with minimal supervision
Ability to assess utilization data
Advanced pharmacy degree (Master's or Pharm.D.) preferred
Managed care knowledge and experience preferred
Medicare Part D and NCQA accreditation knowledge and experience preferred

Core Competencies

Demonstrates expertise in developing and managing pharmacy clinical initiatives, drug formulary programs, and utilization management while ensuring compliance with Medicare Part D and regulatory standards. Possesses strong clinical and analytical skills to assess utilization data and improve quality of care.

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