[Hiring] Clinical Pharmacy Specialist @UPMC

Role Description

UPMC Health Plan is hiring a full-time Clinical Pharmacy Specialist to support the Care Management team within the Pharmacy Services department. This is a work-from-home position, working Monday through Friday 8:30 a.m. to 5:00 p.m. EST. This is a remote position.

The Clinical Pharmacy Specialist provides clinical pharmacy expertise to the development, implementation and management of the pharmacy benefit. The clinical pharmacist assists in the management of pharmacy utilization and provides expertise in managing member care. These services will be provided in compliance with state and federal regulations, NCQA standards, the mission, policies and procedures of Health Plan and Pharmacy Department. Individual should demonstrate professionalism and commitment to meet UPMCHP goals and objectives.

Responsibilities:

• Managing and evaluating therapeutic drug interventions and other clinical pharmacy programs for the purpose of controlling pharmacy trend and improving pharmacy quality measures.
• Regularly interacting with interdisciplinary care teams to help best coordinate care for our members.
• Provide innovative and applicable ideas in clinical program development, utilization management, formulary management, provider education, therapeutic substitution, MTM/DUR, and/or improvements in programs and edits.
• Implement new ideas or improvements as approved, while considering outcomes of the programs.
• Develop and conduct Drug Utilization Review (DUR) activities, Medication Therapy Management (MTM), and other integrated programs with medical management.
• Create, develop, maintain, and enhance clinical reporting programs.

Additional responsibilities include:

• Administrative: Participate in meetings, committees, and work groups both internally and externally as assigned. Maintain a solid understanding of the requirements of the Pennsylvania Department of Health, DPW, CMS and the National Committee for Quality Assurance.
• Communication: Foster and maintain collaborative relationships with internal and external customers. Communicate pharmacy information as appropriate to members, employer groups, and providers.
• Teaching and Education: Mentor students and assist in precepting for the residency program (if applicable).
• Special Skills/Ability to Interact: Ability to function independently, but support team concept. Behavior denotes reliability as demonstrated by prompt attendance and timeliness completing designated workload and follow-up.

Qualifications

• Bachelor of Science Degree in Pharmacy, and/or Doctor of Pharmacy Degree (Pharm.D.) from an accredited U.S. School of Pharmacy.
• Experience in pharmacy benefit management, insurance, managed care preferred.
• Effective communication skills, both written and oral.
• Strong analytical ability and organizational skills.
• Computer literacy for pharmacy programming, word processing, data management.

Requirements

• Registration as a registered pharmacist (RPh), in the Commonwealth of Pennsylvania or eligibility for licensure by examination or reciprocity.
• Continuing Education requirements met each bi-annual cycle for re-licensure, as evident by obtaining a minimum of 30 hours of continuing education every 2 years in structured pharmaceutical education as necessary by the state board.

Preferred Experience

• Managed care residency or 1-3 years managed care experience, preferably in the development and execution of multiple utilization management techniques.
• Managed care residency or 1-3 years managed care experience in formulary development and management, especially in Medicare, Medicaid, Commercial and/or Exchange lines of business.
• Managed care residency or 1-3 years managed care experience or at least 3 years of direct patient pharmacy practice experience, engaging in counseling and clinical services.

Licensure, Certifications, and Clearances

• Registration as a registered pharmacist (RPh), in the Commonwealth of Pennsylvania or eligibility for licensure by examination or reciprocity.
• Continuing Education requirements met each bi-annual cycle for re-licensure.

Company Description

UPMC is an Equal Opportunity Employer/Disability/Veteran.