Job Description

Job Opportunity At Highmark Inc.

Job Summary: This job works as part of a product-line specific (MA, ACA, Commercial) multi-disciplinary team to close gaps in care for high-risk members. Through the multi-disciplinary team, patients who have high risk gaps in care related to medication therapy are transitioned to a pharmacist for case and disease management (CMDM). The incumbent then conducts thorough research to evaluate the patient and extensive clinical judgement and discretion to provide recommendations for closing the gap in care. The incumbent may interact with the patient or care giver, physician, and/or pharmacist through the intervention.

Essential Responsibilities:

• Review gaps in care for high risk patients as part of a multi-disciplinary team.
• Conduct research including gathering claims data, reviewing clinical websites, etc. to thoroughly evaluate each patient's unique situation to provide the appropriate clinical recommendation.
• Contact patients, care givers, physicians, pharmacists, etc. to intervene on identified gaps of care using a high level of clinical judgement and discretion.
• Other duties as assigned.

Education:

• Required: Bachelor's Degree in Pharmacy
• Substitutions: None
• Preferred: Doctorate in Pharmacy

Experience:

• Required: 5 - 7 years in Pharmacy
• Required: 3 - 5 years in Pharmacist - Utilization Management
• Required: 3 - 5 years in Pharmacist - Medical Therapy Management
• Preferred: None

Licenses and Certifications:

• Required: Registered Pharmacist
• Preferred: None

Skills:

• Oral & Written Communication Skills
• Telephone Skills
• Problem Solving & Decision Making
• Compliance
• Collaborative Problem Solving

Language (Other than English): None

Travel Requirement: 0% - 25%

Physical, Mental Demands and Working Conditions:

• Position Type: Office-based Teaches/trains others regularly
• Occasionally: Travel regularly from the office to various work sites or from site-to-site
• Rarely: Works primarily out-of-the office selling products/services (sales employees)
• Never: Physical work site required
• 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.

Pay Range Minimum: $78,900.00

Pay Range Maximum: $147,500.00

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