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Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job will works in a team oriented environment. The incumbent works with Highmark Wholecare Health members on a daily basis to improve engagement and subsequent outcomes as an adjunct to health coaching; will develop and implement physician, pharmacy and member educational initiatives that promote Highmark Wholecare’s formularies, utilization management programs, and case/disease management initiatives; and will participate in cross-functional committees to develop and implement clinical and operational initiatives. The incumbent may also provide consultation into the case and disease management identification process and consult with Highmark Wholecare medical directors when appropriate.

ESSENTIAL RESPONSIBILITIES

+ Work one-on-one with Highmark Wholecare members via face-to-face and/or telephonic interactions. Develop care plans for individual members, coordinate member’s care and assist in the discharge planning process.

+ Represent the organization to members, providers, and other staff at participating practices.

+ Assist in the development and implementation of various programs, including, but not limited to utilization management, disease management and chronic condition management.

+ Address gaps in care, medication adherence and perform medication reconciliation.

+ Collaborate with Highmark Wholecare Health and providers to promote appropriate and cost effective use of medications through adherence to formulary and utilization management requirements.

+ Support Highmark Wholecare Health initiatives to reduce emergency department utilization as appropriate.

+ Collaborate with providers and other staff to develop and implement physician, pharmacy, and member educational initiatives that promote Highmark Wholecare’s formularies, utilization management programs, and case/disease management initiatives.

+ Participate in cross-functional committees to develop and implement clinical and operational initiatives within the pharmacy department.

+ Identify and assist in managing department process improvements to maximize overall efficiencies.

+ Other duties as assigned or requested.

EDUCATION

Required

+ Bachelor of Science in Pharmacy or a Doctor of Pharmacy degree

Substitutions

+ None

Preferred

+ None

EXPERIENCE

Minimum

+ 5 - 7 years of post-graduate pharmacy experience

Preferred

+ 1 - 3 years of related, progressive clinical experience in ambulatory care (as part of three year post-graduate pharmacy experience)

+ Experience with Medicaid populations

+ Post Graduate Year 1 ( _PGY1_ ) residency with concentration in ambulatory care

LICENSES OR CERTIFICATES

Required

+ Registered Pharmacist

Preferred

+ Board Certified Pharmacotherapy Specialists (BCPS)

+ Board Certified Ambulatory Care Pharmacist (BCACP)

SKILLS

+ Strong verbal and written communication skills

+ Microsoft Office (Outlook, Word, Excel)

+ Managed care experience with fundamental understanding of formulary management and utilization management concepts

+ Quickly identify and prioritize issues and requests

+ Prepare and present presentations to stakeholders

+ Appropriately follow up with measurable outcomes

Language Requirement (other than English)

None

Travel Required

0% - 25%

Physical, Mental Demands and Working Conditions

Position Type

Office-Based

General Description for Office-Based Positions

Office-Based: An employee in this position works in an office environment. The position frequently requires the employee to communicate well with others both inside and outside the workplace (e.g., in person, via telephone, via email). The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks. The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.

Teaches / trains others regularly

Occasionally

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)

Does Not Apply

Physical work site required

No

Lifting: up to 10 pounds

Occasionally

Lifting: 10 to 25 pounds

Rarely

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 position 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:

$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.

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For accommodation requests, please contact HR Services Online at [email protected]

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Req ID: J271601