The Pharmacy Benefits Clinical Pharmacist is a dynamic role, responsible for day-to-day clinical and operational oversight of the pharmacy benefit for all assigned plans.
Duties & Responsibilities:
- Works collaboratively to oversee clinical operations of assigned pharmacy benefits
- Provides clinical pharmacy support for the pharmacy benefit —including but not limited to: override requests, external appeals, program design, program implementation/oversight, content creation, training material development, and involvement in the annual Medicare BID and Commercial Product Pharmacy Benefit design
- Collaborates with the Pharmacy Finance Manager, Special Investigations Unit, and PBM to address drug cost trends for assigned plans
- Works with the Finance team to monitor PBM data and activities
- Reviews member, provider, and pharmacy reports, and provides feedback on trends, ideas for improved management, and innovation
- Manages cross-functional projects between Pharmacy and other HF business units
- Collaborates to develop and manage drug related medical coverage policies and formulary for all lines of business
- Presents during monthly Pharmacy Leadership meetings and the Pharmacy Advisory Committee as needed
- Oversees and maintains compliance with all State and Federal agencies
- Precepts Pharmacy Residents and Students
- Additional duties as necessary
Minimum Qualifications:
- Pharmacy degree from an accredited school of pharmacy is required
- Registered Pharmacist with a state license in good standing required
- Strong clinical knowledge of pharmaceuticals and disease states in an effort to identify and recommend opportunities for trend management
- Demonstrated critical thinking and problem-solving skills
- Ability to lead large and small working meetings
- Strong clinical writing, verbal, and presentation skills
- PC Skills with Microsoft Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables)
- Passion for learning/ teaching, promoting access to healthcare, and interest in growing skills in a dynamic environment with various opportunities
Preferred Qualifications:
- PGY1 Managed Care Residency (optional)
- Knowledge of regulations of the Centers for Medicare and Medicaid Services and the New York State Department of Health
- Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefits
- Registered Pharmacist in the state of New York with a license in good standing
- Experience with pharmacy benefit management oversight including maintaining policies and procedures related to formulary design and utilization management processes
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.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to 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.
If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
EEO Law Poster and Supplement
All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.
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.
