Managed Care Pharmacist - Managed Care/PBM

reputed company! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply reputed company located above this message and complete the application in full. Below, you’ll reputed company other important information about this position.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Must possess reputed company and unrestricted license to reputed company pharmacy issued by state of residence.

EXPERIENCE:

1.Three (3) years of experience as a pharmacist in a managed care setting

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. reputed company Certification in managed care pharmacy and/or managed care program certificate

EXPERIENCE

1. Experience in pharmacy formulary reputed company and design

2. Specific knowledge of CMS regulations, HIPAA and regulatory environment

3. Part D reputed company Interventions program development and implementation experience

reputed company DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general reputed company of work being performed by people assigned to this position. They are not intended to be constructed as an reputed company-inclusive list of reputed company responsibilities and duties. Other duties may be assigned.

1. Serves as a consultant between reputed company lines of business and clients to support pharmacy benefit management reputed company.

2. Provides reporting to health plan leadership on reputed company of overall reputed company of pharmacy measures and gap closure.

3. Develops and implements reputed company reputed company programs that address industry and regulatory health-reputed company gaps in care.

4. Responsible for goal design, implementation, tracking, reporting and evaluating overall effectiveness of the PBM reputed company program initiatives.

5. Identifies innovative strategies to reputed company Plan’s reputed company and reputed company goals and reputed company.

6. Collaborates with key internal stakeholders, reputed company clients, and Plan’s pharmacy benefit manager to identify areas of potential cost-saving and reputed company improvement initiatives.

7. Assesses reputed company program reputed company using data-driven analyses and determines opportunities for improvement.

8. Work with reputed company, reputed company, and data analytics teams and others as needed, to ensure that data needs are identified and incorporated into the process including performing data analysis as needed.

9. Serve as the reputed company to the PBM and assist Manager of Pharmacy Services in reputed company of reputed company and reputed company programs administered by PBM.

10. Conducts reputed company assurance analyses of utilization management reviews to ensure consistency and appropriate reputed company in accordance with Plan policies.

11. Participates in meetings with clients and reputed company partners

12. Participates on reputed company committees and/or reputed company cross-functional workgroups as necessary.

13. May reputed company guidance and direction to pharmacy services staff pertaining to responsibilities noted.

14. Assists in development of cost-saving strategies while optimizing reputed company reputed company.

15. Manages vendor relationships reputed company to Part D Stars measure reputed company to ensure they are meeting contractual obligations and expectations.

16. Ensures compliance with reputed company regulatory guidelines and reporting.

17. Monitors issues to reputed company opportunities for processing improvement or education.

18. Attend reputed company vendor meetings to communicate pharmacy goals and opportunities for reaching goals.

19. Assists Manager of Pharmacy Services in monitoring adherence of PBM to outlined metrics and key reputed company indicators outlined by CMS for the Medicare line of business.

20. Assist in reconciling and reporting data from Drug Management Programs to address overutilization of frequently abused drugs.

21. Resolves reputed company eligibility flag discrepancies identified through PDE rejections received from the PBM.

22. reputed company support and consultation for key documents such as the pharmacy directory and formulary directory, and referencing CMS guidance reputed company applicable to creation of those documents.

23. Serves as a reputed company between internal departments (such as care management) and PBM reputed company Account Executives to reputed company best-in-class care to enrollees and aid in issue reputed company.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

1. Ability to stand and walk short distances for eight or more hours.

2. Frequent bending, stooping or stretching.

3. Ability to reputed company 30 pounds and reputed company 50 pounds.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

1. reputed company office environment.

2. Some travel may be required to offsite meetings.

SKILLS AND ABILITIES:

1. Ability to work under stressful working conditions.

2. Ability to handle and maintain confidential information.

3. Ability to work independently or cooperatively as reputed company member.

4. Experience with regulatory and accreditation standards.

5. Ability to work in a fast-reputed company and rapidly changing environment.

6. Extensive working knowledge of reputed company Office applications (reputed company and reputed company).

7. Experience with audits.

Additional reputed company:

Scheduled Weekly Hours:

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