PBM Strategy Pharmacist - Optimize Outcomes & Cost

Peak Health; Harrisburg (Dauphin County); On-site; USD 120,000 - 160,000; Full time

Benefits offered by this job

Restaurant d'entreprise

Job summary

Peak Health is seeking a Managed Care Pharmacist to lead the implementation of the Pharmacy Benefit Manager (PBM) program, broker communication, and ensure alignment with plan benefits. You will educate clients, optimize clinical outcomes, and help reduce pharmacy spend while supporting QA activities and utilization management reviews.

The role involves coordinating with stakeholders, developing clinical quality programs, and overseeing formulary administration and data-driven performance

Qualifications

• Must possess current and unrestricted license to practice pharmacy issued by state of residence.
• 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 (preferred).

Responsibilities

• Serve as consultant between Peak lines of business and clients to support PBM operations.
• Provide reporting to health plan leadership on pharmacy performance measures.
• Develop and implement clinical quality programs addressing gaps in care.
• Oversee PBM formulary administration and benefit interpretation.
• Collaborate with internal/external stakeholders to identify cost-saving and quality-improvement opportunities.
• Monitor clinical program outcomes using data-driven analyses and CMS metrics.

Skills

Regulatory knowledge

Data analysis

Microsoft Excel

Audits

Education

License to practice pharmacy in state of residence

Board Certification in managed care (preferred)

Tools

Microsoft Access

Job description

Peak Health is seeking a Managed Care Pharmacist to lead the implementation of the Pharmacy Benefit Manager (PBM) program, broker communication, and ensure alignment with plan benefits. You will educate clients, optimize clinical outcomes, and help reduce pharmacy spend while supporting QA activities and utilization management reviews.

The role involves coordinating with stakeholders, developing clinical quality programs, and overseeing formulary administration and data-driven performance