Pharmacist - Pharmacy Benefit Management

Oregon Health & Science University; United States; Remote; USD 100,000 - 130,000; Full time

Job summary

Oregon Health & Science University seeks a PBM Pharmacist to provide clinical support in Pharmacy Benefit Management Services. Responsibilities include formulary management, clinical inquiry resolution, and collaboration with pharmacy claims processors. This role requires a current pharmacist's license, relevant experience in managed care, and strong knowledge in drug therapies.

Qualifications

• Current Pharmacist's license issued by the Oregon State Board of Pharmacy required.
• Two or more years in managed care, health plan, or pharmacy benefit management setting preferred.

Responsibilities

• Manage formulary including adjudication and decision-making.
• Resolve clinical inquiries from members, clients, and providers.
• Coordinate with pharmacy claims processors for formulary implementation.

Skills

Drug therapy knowledge

Interpersonal communication

Problem solving

Organizational skills

Education

B.S. Pharmacy or Pharm.D.

Pharmacy practice residency or three years equivalent experience

Job description

Department Overview

The PBM Pharmacist provides clinical support to OHSU Pharmacy Benefit Management Services. Support includes but is not limited to formulary management, coverage determinations, Pharmacy and Therapeutics Committee support, responding to clinical inquiries, and implementing clinical programs.

Function/Duties of Position

1. Formulary management including adjudication, formulary decision-making, and benefit determination.
2. Respond to and resolve clinical inquiries from members, clients, providers, or pharmacies related to formulary options, therapeutic alternatives, and coverage determinations.
3. Oversee the completion of prior authorization requests for members through collaboration with PBM Pharmacy Technicians.
4. Coordinate with pharmacy claims processors to ensure formularies, clinical edits, and plan designs are implemented according to requirements.
5. Assist with developing and presenting drug monographs, executive summaries, therapeutic class reviews, and medication policies to Pharmacy & Therapeutics Committees.
6. Utilize claims data to evaluate benefit design for inappropriate utilization and opportunities to improve outcomes and optimize drug spend.

Required Qualifications

• A current Pharmacist’s license issued by the Oregon State Board of Pharmacy.
• B.S. Pharmacy or Pharm.D.
• Pharmacy practice residency or three years of equivalent work experience.
• Two or more years in managed care, health plan, or pharmacy benefit management setting.

Job Related Knowledge, Skills, and Abilities (Competencies):

• Drug therapy knowledge (dosage, indications, side effects, etc.)
• Contemporary medication use systems
• Drug information through written and verbal consults as well as monographs
• Interpersonal communication
• Excellent organizational skills
• Supervisory concepts (for indirect reports)
• Problem solving

Preferred Qualifications

• PBM operational experience
• Specialty pharmacy practice
• Pharmacy benefit design
• Pharmacy & Therapeutics Committee participation
• Medication policy development
• Pipeline development
• Project management skills

Additional Details

The PBM pharmacist will experience competing demands and frequent interruptions from PBM Technicians, clients, members, and other healthcare professionals.

All are welcome

Oregon Health & Science University values a diverse and culturally competent workforce. We are committed to being an equal opportunity, affirmative action organization that does not discriminate against applicants based on any protected class status, including disability and veteran status. Individuals with diverse backgrounds and those promoting diversity and inclusion are encouraged to apply. For reasonable accommodations, contact the Affirmative Action and Equal Opportunity Department at 503-494-5148 or [e-mail].