Resp & Qualifications

Although this position is REMOTE, candidates are preferred to live in the MD, DC, VA area in order to travel into the offices on occasion.

PURPOSE:
The Quality and Cost of Care Clinical Pharmacist plays critical role in improving and maintaining the quality of care provided to members while also achieving cost savings and implementing efficiencies. This position will support efforts to improve medication-related Stars and HEDIS quality metrics and support Cost of Care ideation and execution plan development to meet specific goals across the Medicaid line of business. Responsibilities include, but are not limited to, collaboration with internal teams and external vendors to design and implement strategies to improve quality metrics, management of the pharmacy Cost of Care idea pipeline to drive towards target goal, oversee and track Cost of Care execution efforts, and perform patient education, medication counseling, drug therapy monitoring, and chronic disease state management for patients in clinical programs. The Quality Clinical Pharmacist will leverage clinical expertise to analyze population health data, identify populations for intervention, and engage providers, members and pharmacies to close gaps in care.

ESSENTIAL FUNCTIONS:

Tracks productivity, quality, impact, and overall performance of Cost of Care and Quality efforts, including pharmacy programs, formularies, and utilization management. Identifies areas where program modifications could improve patient outcomes and reduce costs, particularly within the Medicaid line of business. Collaborates with vendors, PBMs, and internal parties to oversee programs and manage performance, ensuring alignment with Quality and Cost of Care strategic efforts.
Develop and implement strategies to improve Star and HEDIS ratings, focusing on medication adherence, chronic disease management, and patient satisfaction. Work with providers, case managers, and other healthcare professional to ensure coordinated care and adherence to evidence-based guidelines. Conduct Medication Therapy Management reviews, adherence, duplicative therapy, cost containment, and opioid outreaches. Conduct comprehensive medication reviews, reconcile medications, and collaborate with members and providers to ensure appropriate drug therapy
Develops and provides formal written and verbal presentations or other communication materials related to Medicaid Quality and Cost of Care pharmacy programs, pharmacy utilization, pharmacy strategy, and pharmacy topics to a broad audience including both internal and external stakeholders. Present information to various committees including P&T, QIC, MEC, and others. Leads the Corrective Managed Care meetings. Develop and provide formal written and verbal presentations or other communication materials related to pharmacy quality efforts.
Assesses value of Medical Quality and Cost of Care clinical pharmacy programs and strategies through clinical outcomes, usage, quality, and financial metrics to assist in meeting strategic plan goals. Ensures pharmacy programs are compliant with regulatory mandates. Participates in the development and execution of initiatives to improve quality measures.
Provide oversight of external vendor clinical programs to evaluate program performance related to STAR and HEDIS metrics. Conduct meetings with vendors to review key clinical outcomes and progress towards quality improvement goals. Collaborate with vendors, PBMs, and internal parties for oversight of programs and performance management.

QUALIFICATIONS:

Education Level: Ph.D, Pharmacy (Doctorate of Pharmacy)

Experience: 5 years' experience in clinical pharmacy, preferably in a managed care environment
Licenses/Certifications
PHARMD - Licensed Pharmacist Active Maryland and/or DC Registered Pharmacist Upon Hire Req

Preferred Qualifications:
- Experience in Medicaid
- Experience working in healthcare industry with a thorough understanding of prescription benefit management programs and practices.
Knowledge, Skills and Abilities (KSAs)
- Ability to work independently, as well as a member of a team.
- Strong critical reasoning skills in clinical decision-making, planning and organizing.
- Current knowledge of clinical practices and related information systems and computer applications.
- A strong balance between clinical expertise and business acumen.
- Strong interpersonal, written and verbal communication skills, including presentation skills.
- Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
  
  Salary Range: $115,280 - $206,063 (salaries are based on education, experience & internal equity)
  Salary Range Disclaimer
  
  The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
  Department
  
  Government Programs Specialty
  Equal Employment Opportunity
  
  CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
  Where To Apply
  
  Please visit our website to apply: www.carefirst.com/careers
  Federal Disc/Physical Demand
  
  Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on health care programs.
  PHYSICAL DEMANDS:
  The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
  Sponsorship in US
  
  Must be eligible to work in the U.S. without Sponsorship
  #LI-CN1