Description and Requirements
This position will start in January 2025. The Clinical Pharmacist is responsible for efforts to support quality measures for both our Essential Plan and Medicare populations. The Clinical Pharmacist conducts provider and member outreach to address gaps in care measures, support medication adherence initiatives, and assist with strategies to improve quality measures, all while maintaining compliance with all Federal and State agencies. This is a dynamic position requiring the Clinical Pharmacist to stay current with literature, evidence-based medicine, and trends in medicine.
Duties & Responsibilities:
- Support initiatives to resolve gaps in care through direct provider and member outreach, collaboration with provider engagement, and leveraging our pharmacy network capabilities
- Ensure that all recommendations are consistent with the latest guidelines or otherwise supported by the clinical compendia
- Provide clinical pharmacy support to pharmacy technicians as they conduct outreaches to members regarding med adherence, resolve existing barriers to adherence, and use motivational interviewing to improve the health of our members
- Collaborate internally with Marketing, IT, and Enterprise Analytics to assist with the creation of strategic digital communication channels for member outreach
- Identify and resolve same-day grievances reported by members in a timely manner consistent with our policies and procedures
- Oversee and maintain compliance with all State and Federal agencies
- Precept Pharmacy Residents and Students
- Ensure all clinical criteria is in compliance with Center of Medicare and Medicaid Services (CMS) and the New York State Department of Health (NYSDOH)
- Research drug information to maintain drug knowledge and disease state understanding
- Review monthly reports and provide feedback on trends, ideas for efficiency, and innovation
- Additional duties as assigned or required
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Minimum Qualifications:
- Pharmacy degree from an accredited school of pharmacy
- Registered Pharmacist, with a state license in good standing
- Work experience requiring written and verbal clinical communication that is clear, concise, grammatically correct, and professional
- Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefits
Preferred Qualifications:
- Bilingual in English and one or more language(s): Spanish, Mandarin, Cantonese may be required based on business needs
- Ability to work well in a team environment and be a team player
- Demonstrated critical thinking and problem-solving skills
- Passion for learning, promoting the profession of pharmacy, and interest in growing skills in a dynamic environment with various opportunities
- Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local Coverage Determinations
- Ability to lead large and small working meetings
- PC Skills with Microsoft Outlook, Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables)
Compliance & Regulatory Responsibilities: Assists in regulatory and compliance audits for all plans. Ensure all activities are conducted in compliance with regulations.
License/Certification: Licensed pharmacist in good standing
Hiring Range:
- Greater New York City Area (NY, NJ, CT residents): $100,900 - $145,775
- All Other Locations (within approved locations): $86,500 - $128,690
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.