Health Plan Pharmacist

Overview

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.

• Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
• 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.
• Meets face to face or via electronic means with enrollees to provide Medication Therapy Management services.
• Provides educational sessions for MFC associates and enrollees on matters related to pharmacy and medications.
• Participates in meetings and on committees and represents the department and hospital in community outreach efforts.
• Participates in multi-disciplinary quality and service improvement teams.
• Performs other duties as assigned.

Education

• Bachelor's degree in Pharmacy required or Pharm
  
  D 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 and 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 30 days of Med Star start date. within 30 Days required

Knowledge

Skills And Abilities

• Effective verbal and written communication skills.
• Excellent interpersonal and customer service skills especially serving underprivileged…