Job Description

Health Plan Pharmacist at MEDSTAR HEALTH summary:

The Health Plan Pharmacist at MedStar Family Choice oversees the Pharmacy Program, including medication prior authorization, formulary management, and collaboration with government entities. Responsibilities include analyzing pharmaceutical requests, managing Drug Utilization Review initiatives, and ensuring compliance with health standards in Washington, DC and Maryland. The role requires a Bachelor's degree in Pharmacy, a minimum of 3-4 years of experience, and effective communication skills to improve patient care and safety.

General Summary of Position

We are actively recruiting for a Health Plan Pharmacist to join MedStar Family Choice in Washington, DC. This position is primarily day shift with some on-call responsibilities. This position requires the selected candidate to work in the DC office 4 days a week with 1 remote day a week allowed.

The Health Plan Pharmacist manages all aspects of the Pharmacy Program for the health plan including but not limited to: review of all requests for medications requiring prior authorization or other exception; management of the content of the formulary for appropriateness and financial efficiency; preparation, execution, and implementation of Pharmacy and Therapeutics Committee activities and decisions; internal and external reporting; medication therapy management; management of safety recalls in conjunction with the Pharmacy Benefit Manager; creation, implementation, and management of projects related to quality and safety, including Drug Utilization Review (DUR) initiatives; and attendance and participation in meetings with government entities. This position serves as the designated key personnel to the Department of Health Care Finance (DHCF) for all pharmacy related matters and will be anchored to the health plan operations in the District of Columbia. This position has responsibility for Maryland pharmacy operations as well. We recruit, retain, and advance associates with diverse backgrounds, skills, and talents equitably at all levels.

Primary Duties and Responsibilities

• Reviews pharmaceutical requests for formulary medications requiring prior authorization, non-formulary requests, and other medical exceptions.
• Provides consultations with prescribers as needed related to pharmacy requests and formulary guidance.
• Provides analysis and insights into decisions regarding the Health Plan closed formularies for medications with attention to costs.
• Analyzes financial performance and makes recommendations for changes to the formulary to MFC Managers and the Pharmacy and Therapeutics Committee.
• Prepares and submits all required reports to the Maryland Department of Health (MDH) and the District of Columbia Department of Healthcare Finance.
• Manages all aspects of the operation of the Pharmacy and Therapeutic Committee including, but not limited to, preparation, execution, and implementation of Pharmacy and Therapeutics Committee activities and decisions.
• Develops and manages DUR projects in accordance with governmental/jurisdictional requirements.
• Identifies the need for, develops, and manages new and existing Health Plan-initiated Drug Utilization Review projects.
• Maintains Pharmacy Policies and Procedures in compliance with NCQA, COMAR, MDH Pharmacy Standards, District of Columbia Contract and District of Columbia Health Care Finance Administration Pharmacy Division.
• Responsible for tracking updates, communicating, and maintaining compliance with additional pharmacy requirements as they are provided by MDH and District of Columbia Health Care Finance Administration Pharmacy Division.
• Works collaboratively to communicate formulary policies, procedures, and changes to enrollees and practitioners with Outreach, Enrollee Services, Provider Relations, and Health Plan Communications Departments via written letters, newsletter articles, fax messaging, website updates, and other means.
• Collaborates with Pharmacy Benefit Manager for market withdrawals, FDA recalls, and other quality and safety outreach efforts.
• Evaluates situations of potential Fraud, Waste and Abuse if requested by the Compliance Department.
• Provides Medication Therapy Management to enrollees by assessing individual enrollee medication regimens with a focus on interactions, adherence, and patient issues (social determinants of health) with resultant recommendations for optimal medication therapy. Able to effectively convey recommendations to relevant prescribers.

Minimum Qualifications
Education

• Bachelor's degree in Pharmacy or PharmD required and
• Post Graduate Year (PGY)1 required or equivalent experience required

Experience

• 3-4 years Pharmacist experience in ambulatory clinical practice or managed care setting required
• Completion of ASHP-accredited residency in managed care pharmacy or ambulatory care preferred

Licenses and Certifications

• Licensed in the District of Columbia and Maryland required
• If licensed in only one jurisdiction, application for licensing in the other jurisdiction must be submitted within in 30 days of MedStar start date

Knowledge, Skills, and Abilities

• Effective verbal and written communication skills.
• Excellent interpersonal and customer service skills especially serving underprivileged populations.
• Teaching skills to promote healthy behavior change.
• Strong analytical and critical thinking skills.
• Flexibility and the ability to work autonomously as well as take direction as needed.
• Cultural competency.
• Proficient computer skills along with experience using Microsoft applications-Word, Excel, etc. and familiarity with entering data in an electronic medical record (EMR).

This position has a hiring range of $100,588 - $190,340

Keywords:

Health Plan Pharmacist, Pharmacy Program, Medication Management, Drug Utilization Review, Formulary Management, Managed Care, Pharmacy Benefit Manager, Patient Care, Healthcare Compliance, Clinical Pharmacy

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