Clinical Pharmacist (Remote)

Purpose

The Clinical Pharmacist will be part of the Quality/Stars Pharmacy outreach team, playing a critical role in driving Medicare Advantage Star Ratings by improving key pharmacy quality measures, including medication adherence for chronic condition medications, statin use, and polypharmacy safety measures.

Responsibilities

• Conduct outbound and inbound outreach to members to address medication adherence barriers and optimize therapy.
• Engage provider and pharmacies to resolve medication-related issues, including refills, reversed medications, therapy gaps, and clinical interventions.
• Educate members on medication use, adherence strategies, and disease state management.
• Independently manage a daily work queue of prioritized outreach opportunities, ensuring timely and effective completion of outreach, documentation, and follow-up activities.
• Demonstrate strong outcomes by consistently closing gaps and driving measurable results.
• Provide clinical guidance and mentorship to pharmacy technicians supporting outreach, partner with cross-functional teams to optimize program performance.
• Perform comprehensive medication and clinical reviews to identify opportunities for optimization, safety, and adherence.
• Support resolution of clinical and administrative barriers, including prior authorizations, formulary alternatives, medication access issues.
• Identify and resolve social risk barriers impacting medication adherence, i.e., transportation challenges, cost of affordability concerns, and access to care.
• Continuously adapt outreach approach and clinical strategy based on real-time data and performance trends.

Qualifications

• Education Level: Ph.D: Pharmacy (Doctorate of Pharmacy)
• Experience: 5 years experience in clinical pharmacy, preferably in a managed care environment.
• Licenses/Certifications: Upon Hire Required - PHARMD - Licensed Pharmacist Direct Patient Care - Active Registered Pharmacist in Maryland and/or DC.