Duties & Responsibilities:
Support initiatives to resolve gaps in care through direct provider and member outreach, collaboration with provider engagement, and leveraging our pharmacy network capabilities
Ensure that all recommendations are consistent with the latest guidelines or otherwise supported by the clinical compendia
Provide clinical pharmacy support to pharmacy technicians as they conduct outreaches to members regarding med adherence, resolve existing barriers to adherence, and use motivational interviewing to improve the health of our members
Collaborate internally with Marketing, IT, and Enterprise Analytics to assist with the creation of strategic digital communication channels for member outreach
Identify and resolve same-day grievances reported by members in a timely manner consistent with our policies and procedures
Oversee and maintain compliance with all State and Federal agencies
Precept Pharmacy Residents and Students
Ensure all clinical criteria is in compliance with Center of Medicare and Medicaid Services (CMS) and the New York State Department of Health (NYSDOH)
Research drug information to maintain drug knowledge and disease state understanding
Review monthly reports and provide feedback on trends, ideas for efficiency, and innovation
Additional duties as assigned or required
Minimum Qualifications:
Pharmacy degree from an accredited school of pharmacy
Registered Pharmacist, with a state license in good standing
Work experience requiring written and verbal clinical communication that is clear, concise, grammatically correct, and professional
Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefits
Preferred Qualifications:
Bilingual fluency in English and Spanish.
Ability to work well in a team environment and be a team player
Demonstrated critical thinking and problem-solving skills
Passion for learning, promoting the profession of pharmacy, and interest in growing skills in a dynamic environment with various opportunities
Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local Coverage Determinations
Ability to lead large and small working meetings
PC Skills with Microsoft Outlook, Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables)
Compliance & Regulatory Responsibilities: Assists in regulatory and compliance audits for all plans. Ensure all activities are conducted in compliance with regulations.
License/Certification: Licensed pharmacist in good standing
Hiring Range*:
Greater New York City Area (NY, NJ, CT residents): $103,400 - $149,430
All Other Locations (within approved locations): $88,700 - $131,920
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.