Health Outcomes Pharmacist

About the role

This role operates in a hybrid model (T,W,TH) for employees residing within 50 miles of the corporate office. This job is directly responsible for the value creation, impact and cost control, and fiscal/ROI targets as set by the Organization.

Responsibilities

• Serve as the Clinical Pharmacy SME and support broader CTC team in pharmacy related report interpretation and assist in the development of strategies for PCPs and facilities that promote generic substitution, medication adherence, success in pharmacy related Stars and HEDIS measures, completion of comprehensive medication reviews, adherence to pharmacy and medical drug policy, and adherence to the Organization’s formulary.
• Provide office based, hands-on consultative workflow transformation and training/education services to PCPs and facilities enrolled in the Organization's value based reimbursement programs and clinical evidence based guidelines.
• Assess the needs of each individual PCP practice and use a combination of on-site individual office-based, entity-level-based, video conference, teleconference and electronic mail interactions to drive engagement and exemplary value creation, impact and cost control, and ROI/fiscal outcomes as set by the Organization for PCP and facility programs.
• Analyze and interpret PCP and facility value based reimbursement reports in the areas of National Quality Standards like NCQA, HEDIS, NQF, PQRS etc., and cost and utilization and develop strategic plans to meet PCP program targets to create value, impact and cost savings, as well as meeting the ROI as identified by the Organization.
• Provide feedback to and collaborate with data analytics to ensure PCP and facility reports are accurate and provide meaningful, actionable data to PCPs and facilities.
• Independently and autonomously manage PCP and facility caseloads, projects, meetings, deliverables, resources etc. for individualized strategic plans to transform PCP and facility practices enrolled in value based reimbursement program(s) using innovative continuous improvement methodologies. This includes cross training in all of the Organization's value based reimbursement programs to lend support as needed/defined by market outcomes.
• Serve as the clinical SME for PCP value based reimbursement programs, Medicare STARS, Medicaid HEDIS, for both the Organization's internal and external key stake holders. In a matrix management environment, works collaboratively with the interdepartmental team to provide the most comprehensive support to PCPs and facilities for full practice transformation.
• Function as the Organization's representative SME in value based reimbursement programs, pharmacy, and data analysis. This includes creation and presentation of program results to both internal and external audiences, including practice and entity meetings.
• Work collaboratively with other functions in the provider area, data analytics, pharmacy team, and key internal/external stakeholders to provide the most appropriate support to the PCP's based upon data analysis and dashboard reports.

Requirements

• Required: Bachelor's Degree in Pharmacy
• Preferred: Master's Degree in Health Administration or Business or Doctorate Degree in Pharmacy (PharmD)
• Required: 3 - 5 years in Pharmacy
• Required: 3 - 5 years in a Clinical Practice or Completion of PGY-1 Residency or Completion of a Pharmacy Fellowship
• (Any one of the following preferred): 5 - 7 years in Medicare, 5 - 7 years in Managed Care Support, 3 - 5 years in Quality Improvement, 3 - 5 years in Care Management, 3 - 5 years in Utilization Review, 3 - 5 years in the Health Insurance Industry
• Required: Registered Pharmacist License
• Preferred: Board Certified Pharmacotherapy Specialist, Board Certified Ambulatory Care Pharmacist, Board Certified Geriatric Pharmacist

Qualifications

• Required: Analytical Skills, Medicare, Presentation Delivery, Managed Care, Healthcare, Care Planning, Continuous Improvement, Utilization Management, Healthcare Management, Utilization Review
• Preferred: Language (Other Than English) None
• Physical, Mental Demands and Working Conditions: Position Type Office-Based, Teaches / trains others regularly, Constantly Travel regularly from the office to various work sites or from site-to-site, Frequently Works primarily out-of-the office selling products/services (sales employees), Never Physical work site required, Yes Lifting up to 10 pounds, Occasionally Lifting 10 to 25 pounds, Occasionally Lifting 25 to 50 pounds

Skills

• Required: Analytical Skills, Medicare, Presentation Delivery, Managed Care, Healthcare, Care Planning, Continuous Improvement, Utilization Management, Healthcare Management, Utilization Review
• Preferred: Language (Other Than English) None

Benefits

N/A

Pay

Pay Range Minimum: $108,600.00
Pay Range Maximum: $180,600.00

Schedule

Hybrid model (T,W,TH) for employees residing within 50 miles of the corporate office.