Pharmacy Services Specialist

About the role

Provides analytic and clinical support related to the management of Health Plans from VNS Health Plans's pharmacy benefit programs across all business lines. Resolves problems regarding Pharmacy Benefit Manager (PBM) clinical pharmacy benefit services. Serves as a clinical pharmacy resource for clinical staff with medication management questions or pharmaceutical problems. Works under general supervision. This is a hybrid position in Manhattan.

Responsibilities

• Assists with the preparation of pharmacy data reports and analysis that meets the planning, clinical, quality, and regulatory needs of the corporate entity and all lines of business, working with the Medical Management, Data Management, Finance Departments and clinical operations.
• Assists with the administration of Medication Management Programs, working collaboratively with other teams, including medication reconciliations and other quality pharmacy metrics driven clinical interventions in caring for older adults.
• Participates in PBM delegated services oversight role for Prior Authorization and appeals processes related to pharmacy claims.
• Participates in multidisciplinary clinical rounds by working up members’ medications for potential medication related issues and serve as medication management expert for other members of the team.
• Participates in reviewing denied pharmacy claims for appropriateness of rejection and point-of-sale messaging.
• Led member experience initiatives related to denied pharmacy claims to facilitate access to drugs and improve member experience with drug plan.
• Responds to, researches and resolves any problems related to member complaints regarding Pharmacy Benefit Manager (PBM) clinical pharmaceutical services.
• Participates in Quality Improvement projects; Utilization Review; Individual Drug Profile Review; and Pharmacy Standard and Protocol Development.
• Serves as a clinical pharmacy resource for clinical staff with medication management questions or pharmaceutical problems, interacting with physicians when required.
• Assists Pharmacy Services team in the development, provision and maintenance of drug research resources and other educational materials related to pharmaceutical management.
• Delivers pharmacy benefit related education and training as needed, including new employee orientation.
• Collaborates with Manager to help VNS Health Health Plans achieve goals in pharmacy related Stars targets.
• Participates in special projects and performs other duties as assigned.

Qualifications

• Licensed and registered in New York State to Practice as a Registered Pharmacist required.
• Valid driver's license or NYS Non-Driver photo ID card, may be required as determined by operational/regional needs.
• Doctorate in Pharmacy (PharmD) required.
• Minimum of two years of pharmacy experience required.
• Experience in Medicare Part D regulations and NY State regulations for Medicaid preferred.
• Experience in a managed care and/or clinical care setting and geriatric pharmacy management, including experience in developing and providing professional and patient educational programs in pharmaceutical care preferred.
• Experience in the use and analysis of pharmaceutical data and databases preferred.
• Ability to use software and knowledge of Microsoft Word, Excel and Power Point required.

Pay

USD $98,200.00 - USD $130,800.00 /Yr.