[Hiring] Clinical Pharmacist, Utilization Management and Oversight @GEHA Health

Role Description

The Utilization Management and Oversight Pharmacist will assist with corporate strategy to achieve better healthcare value and lower cost for our members, while ensuring quality pharmaceutical care for our members, in an effort to make our insurance product more competitive and support growth.

The Utilization Management and Oversight Pharmacist widely supports the operation of the pharmacy benefit and its functional teams. The position will be responsible for the following:

• Insuring proper medication utilization among our membership
• Developing and maintaining customized prior authorization criteria
• Developing and maintaining custom benefit exclusions
• Completing enterprise-wide drug information requests
• Preparing pharmacy recommendations for the pharmacy leadership
• Proposing and implementing pharmacy benefit design changes
• Increasing member outcomes by collaborating with other departments within the enterprise
• Supporting utilization review strategies and risk management related to the utilization of pharmaceuticals
• Collaborating with staff responsible for day-to-day activities of the Pharmacy Department
• Coordinating with other departments within the organization (ie: Care Management, SIU, Product, Marketing) to support strategic and operational objectives of the Pharmacy Department.

Qualifications

• Doctor of Pharmacy (PharmD) degree from an ACPE-accredited School of Pharmacy
• Postgraduate training/residency required
• Candidate must be licensed, or eligible for licensure, within the state of Missouri
• Candidate must have 5 years of experience, or completion of a PGY-1/PGY-2 residency with a managed care and/or drug information focus preferred
• Minimum three (3) years of managed care experience that has involved interaction with patients, providers and other healthcare professionals
• Knowledge of managed care pharmacy principles including medical exception reviews, formulary management, and utilization review required
• Candidate should possess an extensive understanding of evidence-based pharmacy practice, including disease specific therapies along with knowledge and ability to search medical literature for supporting clinical references

Requirements

• Must contribute to the One Team value of GEHA, be organized and have the ability to handle multiple projects
• Exemplary interpersonal, communication and organizational skills
• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles, and accountability
• Proficient in Microsoft Office (Outlook, Word, Excel, Vizio and PowerPoint)
• Solid understanding of government scope (FEHB, OPM, FDA, ACA, USPSTF) required
• Competency in compendia navigation and research
• Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office
• A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required
• Latency (ping) response time lower than 80 ms
• Hotspots, satellite and wireless internet service is NOT allowed for this role
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Benefits

• Competitive pay/salary ranges
• Incentive plan
• Health/Vision/Dental benefits effective day one
• 401(k) retirement plan: company match – dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution
• Robust employee well-being program
• Paid Time Off
• Personal Community Enrichment Time
• Company-provided Basic Life and AD&D
• Company-provided Short-Term & Long-Term Disability
• Tuition Assistance Program