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J202787

Lead Pharmacist

Highmark Inc.

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

Company :

Highmark Inc.

Job Description : 

JOB SUMMARY

This job works in a team oriented environment acting as the pharmacy line of business subject matter expert (SME) to develop and execute the strategic clinical and operational components of the prescription drug formularies for their applicable line of business, including the Commercial, Healthcare Exchange or Medicare Part D prescription drug benefit.  The incumbent will leverage their clinical and operational expertise to develop and implement prescription drug benefit utilization management programs to ensure safe and appropriate use of medications and reduce care costs for our customers.  Will have oversight for utilization management programs specific to their line of business including but not limited to: prior authorization, dose and duration edits, quantity limits and step-therapy edits.  The incumbent will collaborate with other pharmacy team members to vet clinical formulary and utilization management program recommendation for their specific line of business through the Pharmacy & Therapeutics (P&T) Committee.  Will support state and federal audit activities pertaining to their specific pharmacy line of business and be responsible for executing all state and/or federal filing requirements related to formulary and utilization management programs. Will participate in specific cross-functional workgroups with inter-disciplinary teams including but not limited to Product, Legal, Actuary, Analytics, Sales, Government Affairs, and Benefit Coding.  The incumbent will effectively collaborate with key external vendors, including the pharmacy benefit manager (PBM), to ensure accurate and efficient coding strategies for custom formulary and utilization management programs for their specific line of business.  The incumbent will be expected to present to Sr. Leadership information on trends and provide recommendations for optimizing formulary performance.

ESSENTIAL RESPONSIBILITIES

  • Lead the development, implementation and maintenance of custom prescription drug formularies for specific pharmacy line of business (e.g., Commercial, Healthcare Exchange, Medicare Part D).
  • Lead the development and implementation of custom utilization management programs for specific pharmacy line of business including but not limited to: prior authorization, dose and duration edits, quantity limits and step-therapy edits.
  • Serve as line of business pharmacy subject matter expert (SME) for state and federal government audits pertaining to formulary and utilization management programs. Lead development and submission of all required state and/or federal government regulatory  filings for specific pharmacy line of business, as applicable .
  • Participate in cross-functional workgroups with interdisciplinary teams including but not limited to Product, Legal, Actuary, Analytics, Sales, Government Affairs, and Benefit Coding, to implement strategic pharmacy benefit programs for specific pharmacy line of business.
  • Effectively collaborate with key external vendors, including pharmacy benefit manager (PBM), to accurately and efficiency implement coding strategies for custom formulary and utilization management programs for specific line of business (e.g., Commercial, Healthcare Reform or Medicare Part D).
  • Partner with internal Marketing and Sales teams to develop and implement physician, pharmacy, account, and member educational initiatives that promote the Highmark-specific formularies and utilization management programs for each line of business. Present to Sr. Leadership information on trends and provide recommendations for optimizing formulary performance.
  • Identify and assist in managing department process improvements with internal and external partners to maximize overall efficiencies.
  • Manage individual projects for timely review with direct and senior leadership in Pharmacy Services.
  • Other duties as assigned or requested.

EDUCATION

Required

  • Bachelor's Degree in Pharmacy

Substitutions

  • Completion of PGY-1 Managed Care Pharmacy residency program

Preferred

  • Doctorate in Pharmacy

EXPERIENCE

Required

  • 5 years of related progressive experience in pharmacy area of specialization
  • 1 year of working directly with pharmacy vendors, such as pharmacy benefits manager, in clinical program coding
  • 1 year of with clinical pharmacy initiatives to generate care cost savings/manufacturer contracting opportunities  

Preferred

  • 1 year of leading formulary and utilization management program implementation for a specific pharmacy-benefit line of business, such as Commercial, Healthcare Exchange or Medicare Part D 
  • Completion of 1 year in an accredited PGY-1 managed care pharmacy residency program

LICENSES or CERTIFICATIONS

Required

  • Registered Pharmacist (Non-State Specific)

Preferred

  • None

SKILLS

  • An understanding of managed care pharmacy principles and practices is essential
  • Demonstration of strong verbal and written communication skills, as well as proficiency in the use of computer-based data processing
  •  Microsoft Office products, and database applications
  • Be able to quickly identify and prioritize essential elements of problem
  • Independently or in a team, be able to identify the root issues and formulate potential solutions

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Occasionally

Works primarily out-of-the office selling products/services (sales employees) 

Never

Physical work site required 

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

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 job 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.

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


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