Highmark Health Jobs

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job is responsible for the unique environment that grants exposure to a multifaceted approach to managed care pharmacy, including clinical management, sales, operations, and scholarly activities. The incumbent is an integral part of the clinical team and will participate in virtually all of the daily clinical activities and operations as the full-time pharmacists, such as performing clinical reviews, policy writing, formulary updates, and Medication Therapy Management for Medicare Part D. Presents professional posters at a national meeting of managed care organizations and/or publish articles in peer-reviewed professional journals. Required and elective rotations will provide the resident with exposure to diverse experiences such as specialty pharmacy, sales and marketing, regulatory and compliance, contracting and manufacturer relations, Senior Products, journal clubs, new drug presentations, direct patient care, and various teaching opportunities.

ESSENTIAL RESPONSIBILITIES

• Develop exceptional written and verbal communication skills, demonstrated through daily professional interactions; preparing provider, member, and group communications; oral presentations; poster presentations; and/or article publication.

• Oversee day-to-day operations of the drug utilization review (DUR) initiatives within the Medical and Pharmacy Affairs department, including reviewing cases and consulting with internal and network physicians.

• Develop policies related to new DUR initiatives as well as communications to disseminate the information to members, network providers, and internal staff.

• Develop a detailed understanding of the managed care business and the potential roles of pharmacists within the managed care setting.

• Perform an evaluation of both a new medication as well as a class review based on efficacy, safety, unique value, and cost parameters utilizing drug information skills.

• Gain an understanding of regulatory and legislative issues impacting the health care industry with a focus on managed care.

• Conduct rotations in areas including Specialty Pharmacy, Sales and Marketing, and Manufacturer Relations and Contracting to include

• Identify market trends and changes in utilization, in order to propose new prescription drug benefit changes to help manage the rising costs of healthcare.

• Participate in patient care activities including case management rounds and Medication Therapy Management. Review member’s prescription drug claim profile and make accurate and meaningful suggestions for improvement.

• Conduct research and prepare documents that will be used by committees of the Organization to determine Formulary status of medications, as well as any strategic management programs that could apply to individual drugs or entire classes of medications.

• Gain an understanding of prescription drug benefit design, including an understanding of the formulary process and components of different types of formularies (open, closed, multi-tiered).

• Develop criteria used to evaluate a request for non-formulary drug coverage, evaluate a prior authorization request, or evaluate a managed prescription drug coverage request.

• Participate in the clinical evaluation process for determining whether coverage for non-formulary medications and/or prior authorizations will be approved.

• Gain an understanding of the benefit consultant’s role in evaluating trends in current benefit structures and opportunities for managing benefits.

• Participate in journal club, research projects, and seminar presentations either on-site at Highmark or at the University of Pittsburgh.

• Medicare Part D file management and Pipeline drug database management.

• Other duties as assigned or requested.

EDICATION

Required

• Doctor of Pharmacy (PharmD)

Substitutions

• None

Preferred

• None

EXPERIENCE

Required

• None

Preferred

• Retail, Hospital, or other Pharmacy experience preferred

• Strong computer skills including word processing, spreadsheet and database end user experience as well as strong verbal and written communication skills

LICENSES AND CERTIFICATIONS

Required

• Licensed pharmacist in Pennsylvania, licensure pending successful completion of Pennsylvania State Board Exam, or ability to reciprocate license. Must be licensed in Pennsylvania no later than October 31 of the year the position is started

Preferred

• None

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

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 their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

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Req ID: J243615