Health Outcomes Pharmacist - Phoenix - Phoenix Staffing Services

Description

Job Opportunity At Highmark Inc.

Job Summary: This position is directly responsible for the value creation, impact and cost control, and fiscal/ROI targets as set by the organization. This includes revenue stream outcomes and engagement of primary care providers (PCP) and facilities enrolled in the organization's value based reimbursement programs, clinical care models, and continuous improvement models. The incumbent applies subject matter expertise in clinical pharmacy, pharmacy formulary, pharmacy benefit design, pharmacy policy, medical drug policy, therapeutic alternatives, medication adherence strategies, medication therapy management, utilization management, immunizations, specialty pharmacy, Medicare Stars, and Medicaid HEDIS to strategies designed to promote the organization's value based reimbursement PCP and facility programs.

Essential Responsibilities:

• Serve as the clinical pharmacy subject matter expert (SME) and support broader 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 data for the highest ROI opportunities in PCP performance, and implement strategic plans to meet identified program targets across all of the organization's value based programs for both the commercial and government business (ACA, Medicare STARS, Medicaid HEDIS, risk revenue).
• 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.
• 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.
• 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 stakeholders. 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 in a matrixed role supporting the development and strategic integration of clinical care models for chronic conditions and in collaboration with departments across the enterprise.
• Other duties as assigned.

Education:

• Required: Bachelor's Degree in Pharmacy
• Substitutions: None
• Preferred: Master's Degree in Health Administration or Business or Doctorate Degree in Pharmacy (PharmD)

Experience:

• Required: 5 - 7 years in Pharmacy or 3 - 5 years in a Clinical Practice or Completion of PGY-1 Residency or Completion of a Pharmacy Fellowship
• Preferred (any one of the following): 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

Licenses and Certifications:

• Required: Registered Pharmacist License
• Preferred: Board Certified Pharmacotherapy Specialist, Board Certified Ambulatory Care Pharmacist, Board Certified Geriatric Pharmacist

Skills:

• Analytical Skills
• Medicare
• Presentation Delivery
• Managed Care
• Healthcare
• Care Planning
• Continuous Improvement
• Utilization Management
• Healthcare Management
• Utilization Review

Language (Other than English): None

Travel Required: 50% - 75%

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 Occasionally

Pay Range Minimum: $78,900.00 Pay Range Maximum: $147,500.00 Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.