Skip To Content
Laptop
J195975

Manager Clinical Pharmacy

Highmark Inc.

  • Company Highmark
  • Home, PA
  • Pharmacy
  • Full time
  • Day (United States of America)

Company :

Highmark Inc.

Job Description : 

JOB SUMMARY (Summarizes the major purpose and primary responsibilities)

This position is responsible for managing a number of clinical and financial aspects of the prescription drug benefit for all lines of business. These aspects include continuous formulary development, pharmacy and therapeutics process, inception and implementation of clinical policy and programs such as prior authorization, step therapy and quantity limit programs, utilization review, quality management, compliance with regulatory standards, reports, etc. in a manner that will improve the quality of care while controlling utilization and containing costs.

ESSENTIAL RESPONSIBILITIES (Describes the critical tasks, duties and responsibilities of the position.)

  • Performs management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
  • Plans, organizes, staffs, directs and controls the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority.
  • Leads the development of policies and procedures related to drug utilization review programs. Evaluates total cost of care, as well as, direct pharmacy costs. Manages all drug utilization review programs in all settings. Develops, maintains, and measures effectiveness of various drug utilization programs.
  • Ensures that all quality guidelines, as well as, legal regulations are met. Directs clinical utilization review programs for all drug-related claims. Consults, develops, and implements on policy and procedure for drug utilization to ensure optimal quality of care and cost effectiveness.
  • Provides clinical expertise for formulary management programs, presents information about new drugs; implements prior authorization programs, step therapy programs, quality limits and the like. Performs drug class evaluations, monograph development and clinical decision support.
  • Serves as a resource of drug information for other departments. Responsible for maintaining the Highmark on-line drug formularies. Publishes changes, additions, deletions, new programs in all applicable publications and /or on-line resources.
  • Other duties as assigned or requested.

REQUIRED EDUCATION

Bachelor's Degree- Pharmacy

Substitutions (Acceptable substitutions in lieu of a degree 1 ½ years’ experience  = 1 year college)

No Substitutions

PREFERRED EDUCATION

Pharmacy (Pharm-D)

EXPERIENCE

Minimum: This section refers to the minimum years and type of applicable experience needed to perform the job.  Minimum requirements must be non-comparative, objective, and relevant.

  • 3 years' experience as a hospital or community pharmacist, experience working as a clinical pharmacist (non-dispensing role) with managed care insurer or pharmacy

Preferred: This section refers to additional desired years and type of experience that the hiring manager would prefer, above and beyond the basic requirements of the job.

  • Pharmacy Residency (PGY1) and/or Board Certification (e.g., BCPS, etc.)
  • 3 or more years in a management/leadership role with a managed care insurer or pharmacy benefits management company.
  • Utilization Management process experience
  • Pharmacy and Therapeutics Committee experience
  • Data analysis of drug and/or medical claims
  • Experience in reviewing and making recommendations based on comparative effectiveness data and/or drug trend reports

KNOWLEDGE, SKILLS & ABILITIES ( List the attributes required to perform the job through demonstrated service, education or training)

  • Knowledge of utilization management processes, procedures, and staffing
  • Knowledge of Formulary Management, Clinical Policy, Care Cost Management, and Quality Improvement initiatives and programs
  • Knowledge of regulatory requirements and measurements such as Medicare, Medicaid, DOL, DOH, DOI, NCQA, STARs, QRS, affecting business
  • Ability to speak publicly and communicate effectively through a variety of mediums (electronic, written, etc.)
  • Using logic and reasoning to identify the pros and cons of alternative solutions, conclusion, or appropriate approaches to challenges
  • Understanding the implications of new information for both current and future decision making (i.e., seeing the big picture)

REQUIRED LICENSURE (Licenses that are required to perform the job)

Active and Unrestricted Pharmacist (RPh) License

PREFERRED LICENSURE

Pennsylvania Licensed or eligible

TRAVEL REQUIREMENT: 0 - 25%
(List % of time traveling)

LANGUAGE REQUIREMENT ( other than English )?  
(List primary language)

PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS
( The physical, mental demands and working conditions described here are representative of those that must be met by an employee to successfully perform the essential function of their job. Reasonable accommodations will be made when necessary to enable individuals with disabilities to perform the essential duties of the position, to the extent that they do not cause undue hardship.

Position Type:

Office-Based

Office-Based Positions

An employee in this position works in an office environment.  The position frequently requires the employee to communicate effectively 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., computers and 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 - Does Not Apply

Travels regularly from the office to various work sites or from site-to-site - Does Not Apply

Works primarily out-of-the office selling products/services (Sales employees) - Does Not Apply

Physical Work Site Required - No

Most On-The-Road Positions

An employee in this position may work in a home or company office environment but is also frequently driving to and from various locations to perform the work off-site.  The position frequently requires the employee to communicate effectively 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., computers and 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.

Non-Office-Based Positions

An employee in this position is frequently required to move throughout the workplace, sit, stand and walk, use hands and fingers to hold objects, tools or controls, possess fine motor skills (e.g., to write and operate a computer or to steer transportation equipment), possess gross motor skills (e.g., to carry items), reach with hands and arms, climb stairs and ladders, balance, stoop, kneel crouch and crawl, communicate effectively, and talk and hear. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.  The employee must be able to work in a busy environment where decisions often must be made quickly, must attend work on a regular and reliable basis, must adhere to all workplace policies, and may be called upon to work outside regular business hours.  This work occurs in a [example: warehouse, hospital or provider’s office or mail room].

Lifting: up to 10 pounds - Does Not Apply

Lifting: 10 to 25 pounds - Does Not Apply

Lifting: 25 to 50 pounds - Does Not Apply

ADDITIONAL INFORMATION

Changes Approved By:

Kathleen Thompson

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

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 their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

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 their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice


Thumbnail Join Talent Community@2X

Connect with a career that’s right for you.

Introduce yourself and we'll get in touch monthly to share career insights and company news.

Join Our Talent Community