Job Description

Job Description

UPMC Health Plan has an exciting opportunity for a Senior Clinical Pharmacy Specialist in the Pharmacy Services department. This is primarily a work-from-home position but may require coming into the office, which is located in downtown Pittsburgh, various times throughout the year. Working hours are Monday through Friday 8:30 a.m. to 5:00 p.m. 

Registration as a registered pharmacist (RPh), in the Commonwealth of Pennsylvania or eligibility for licensure by examination or reciprocity is required.

This job provides clinical pharmacy expertise to develop, implement, and manage the pharmacy benefit. The Senior Clinical Pharmacist assists in managing pharmacy utilization and provides expertise in managing member care. These services will be provided in compliance with state and federal regulations, NCQA standards, the mission, policies, and procedures of the Health Plan and Pharmacy Department. The individual should demonstrate professionalism and commitment to meeting UPMCHP goals and objectives.

• The Senior Clinical Pharmacist must demonstrate multiple years of being a consistent, high-performing team member as measured by both volume and quality of work performed. In addition to consistent, exceptional performance, the Senior Pharmacist must have already demonstrated their initiative and ability to work independently. This role will have completed several stretch projects as outlined by their manager. The stretch projects, in addition to all new projects, would then be the ongoing responsibility of the Senior Pharmacist to manage. This may include but is not limited to, training other staff, actively participating and contributing solutions in strategic discussions, assisting with internal and external audits, and creating and assisting with workflow improvement and efficiency initiatives. Additionally, the Senior Clinical Pharmacist will assist in finding new clinical, quality, and efficiency improvements through the management of the Formulary, Prior Authorization, and other clinical programs. This role is responsible for the successful and satisfactory completion of additional projects that are beyond their day-to-day tasks. 
• The Product Development Pharmacist is responsible for: Assisting with clinical management of the designated line of business (Commercial, Exchange, Medicare, Medicaid, Exchange, and/or CHIP) from a pharmacy formulary and operational perspective and for understanding and complying with rules and regulations affecting the business. Develop and revise various formularies for each line of business including sending communications, training of identified departments, updating all brochures, updating appropriate websites, and submitting change forms. Review new drugs promptly and submit change forms as appropriate. Research adequately and be properly prepared for all P&T Committee meetings, ensuring all recommendations for both new drugs and new policies are appropriate and have been discussed with subject matter experts. Present these assignments succinctly and at a suitable pace and answer relevant questions.
• Provide innovative ideas for new and existing clinical program development, utilization management, formulary management, provider education, and therapeutic substitution programs. Work with employer clients, account management, and sales in meetings as assigned to improve the understanding of the pharmacy benefit, as well as offering recommendations. 
  Additional responsibilities for the Sr Pharmacist include:
• Administrative Participate in meetings, committees, and work groups both internally and externally as assigned. Maintain a solid understanding of the requirements of the Pennsylvania Department of Health, DPW, CMS, and the National Committee for Quality Assurance, specifically as they relate to the expectations of pharmacy operations. Ensure compliance with regulatory and accreditation requirements of clinical functions. Communication Foster and maintain collaborative relationships with internal and external customers. Communicate pharmacy information as appropriate to members, employer groups, and providers. Develop communication materials to providers, including discussions regarding formulary changes/adherence, health education, medication compliance, and trend management.
• Teaching and Education Mentor students and assist in precepting for the residency program if applicable. Assists in the training of pharmacy personnel.
  Special Skills/Ability to Interact: Have the ability to function independently, but support team concept. Behavior denotes reliability as demonstrated by prompt attendance and timeliness in completing designated workload and follow-up. Conveys and maintains professional image while interacting with coworkers, providers, and clients. Honor client and patient confidentiality.

• Bachelor of Science Degree in Pharmacy, and/or Doctor of Pharmacy Degree (Pharm.D.) from an accredited U.S. School of Pharmacy.
• Experience in pharmacy benefit management, insurance, and managed care preferred and be knowledgeable in therapeutic interventions and other cost containment programs.
• Product Development - Managed care residency or 1-3 years of managed care experience in formulary development and management, especially in Medicare, Medicaid, Commercial and/or Exchange lines of business.
• Effective communication skills, both written and oral. Must have strong analytical ability and organizational skills. Computer literacy for pharmacy programming, word processing, and data management.
• Assessment of job-related skills and competency will be reviewed annually via daily functioning, job-related documentation, department-based competency programs, and continuing education activities.
  
   

Licensure, Certifications, and Clearances:
Registration as a registered pharmacist (RPh), in the Commonwealth of Pennsylvania or eligibility for licensure by examination or reciprocity. Continuing Education requirements met each bi-annual cycle for re-licensure, as evident by obtaining a minimum of 30 hours of continuing education every 2 years in structured pharmaceutical education as necessary by the state board

• Pharmacist
• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran

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