PBM & Managed Care Pharmacist: Strategy & Outcomes

Peak Health; United States; Sur place; USD 110 000 - 150 000; Plein temps

Résumé du poste

Peak Health is seeking a Managed Care Pharmacist to lead PBM implementation, broker communications, and ensure alignment with plan benefit design. The role educates clients on pharmacy benefits, optimizes clinical outcomes, and helps reduce spend while supporting QA activities in utilization management reviews.

Responsibilities include monitoring clinical program outcomes, collaborating with data analytics teams, and ensuring regulatory compliance across CMS guidelines and Part D initiatives.

Qualifications

• Must possess current and unrestricted license to practice pharmacy.
• Three (3) years of experience as a pharmacist in a managed care setting.
• Board Certification in managed care pharmacy and/or managed care program certificate.
• Experience with CMS regulations, HIPAA and regulatory environment.
• Part D Clinical Interventions program development and implementation experience.

Responsabilités

• Serves as a consultant between Peak lines of business and clients to support pharmacy benefit management operations.
• Provides reporting to health plan leadership on progress of overall performance of pharmacy measures and gap closure.
• Develops and implements clinical quality programs that address industry and regulatory health-related gaps in care.
• Responsible for goal design, implementation, tracking, reporting and evaluating overall effectiveness of the PBM clinical program initiatives.
• Identifies innovative strategies to impact Plan's quality and clinical goals and outcomes.
• Collaborates with key internal stakeholders, external clients, and Plan's pharmacy benefit manager to identify areas of potential cost-saving and quality improvement initiatives.

Connaissances

Regulatory knowledge

CMS regulations

Data analytics

Pharmacy operations

Part D Stars reporting

Experience in managed care pharmacy

Formation

Pharmacy license

Board Certification in managed care (preferred)

Outils

Excel

Access

Description du poste

Peak Health is seeking a Managed Care Pharmacist to lead PBM implementation, broker communications, and ensure alignment with plan benefit design. The role educates clients on pharmacy benefits, optimizes clinical outcomes, and helps reduce spend while supporting QA activities in utilization management reviews.

Responsibilities include monitoring clinical program outcomes, collaborating with data analytics teams, and ensuring regulatory compliance across CMS guidelines and Part D initiatives.