Pharmacy Resident: Clinical & Formulary Analytics

MetroPlusHealth; New York (NY); On-site; USD 55,000 - 70,000; Full time

Job summary

MetroPlusHealth in New York is seeking a Pharmacy Resident to audit and validate benefit configurations, support formulary management, and strengthen patient care across all lines of business. The role emphasizes clinical program development, medication reconciliation, and care management through rotations.

The resident will advance evidence-based decision making, collaborate with clinical teams, and contribute to quality initiatives, audits, and education for staff on new therapies and

Qualifications

• Doctor of Pharmacy degree required.
• Experience in a managed care environment preferred.
• Experience in auditing preferred.
• Experience in Pharmacy management of government programs (Medicaid and Exchange) preferred.
• Experience in the evaluation and interpretation of pharmacy claims data is preferred.
• Proficiency with MS Word, Excel, and PowerPoint is required.

Responsibilities

• Reviews daily claims reports to identify accuracy of pharmacy benefit configuration across lines of business.
• Reviews daily rejection reports to identify inconsistencies affecting patient care.
• Validates improper coding between POS and UM platforms.
• Coordinates care between members, pharmacies, and providers to improve adherence.
• Assists in formulary and utilization management for medications across lines of business.
• Develops drug monographs and coverage criteria upon request.
• Completes retro utilization reviews for drugs of interest and analyzes results.
• Participates in quality initiatives and monthly KPI reports.

Skills

Auditing

Teamwork

Education

Doctor of Pharmacy (PharmD)

Tools

MS Word

Excel

PowerPoint

Job description

MetroPlusHealth in New York is seeking a Pharmacy Resident to audit and validate benefit configurations, support formulary management, and strengthen patient care across all lines of business. The role emphasizes clinical program development, medication reconciliation, and care management through rotations.

The resident will advance evidence-based decision making, collaborate with clinical teams, and contribute to quality initiatives, audits, and education for staff on new therapies and