Senior Health Outcomes Pharmacist

Company : Highmark Inc. Job Description : JOB SUMMARY The Senior Health Outcomes Pharmaicst leads the development and execution of strategic pharmacy initiatives that optimize drug spend, improve member health outcomes, and align with Highmark's overall business objectives. This role involves in-depth market analysis, collaborative program development, and proactive stakeholder engagement to identify opportunities for innovation and ensure compliance with evolving regulations. By leveraging clinical expertise and strategic thinking, the consultant drives data-informed decisions that enhance the value of Highmark's pharmacy benefit program and contribute to a more sustainable healthcare system. ESSENTIAL RESPONSIBILITIES Develop and Implement Strategic Pharmacy Programs internally and in partnership with our external entity partners Provide Clinical Expertise and stakeholder engagement for all VBR contracts across the market Financial Analysis, cost management Data Analysis and reporting Other duties as assigned or requested. EXPERIENCE Required 5 years of experience in pharmacy practice or equivalent training (Residency) 5 years of Experience in managed care, pharmacy benefit management (PBM), or health plan setting. 3-5 years in health system consulting Preferred (any one of the following) 5 - 7 years in Medicare 5 - 7 years in Managed Care Support 3 - 5 years in Quality Improvement 3 - 5 years in Care Management 3 - 5 years in Utilization Review 3 - 5 years in the Health Insurance Indus Master's Degree in Health Administration or Business Advance Degree in Pharmacy (Board Certification) SKILLS Clinical Knowledge: Possesses a strong foundation in pharmacology, therapeutics, and disease state management to effectively evaluate medication use and inform program development. Analytical Skills: Demonstrates proficiency in data analysis, statistical methods, and financial modeling to identify trends, assess program performance, and inform strategic decision-making. Communication Skills: Exhibits excellent written and verbal communication skills to clearly and concisely convey complex information to diverse audiences, including senior management, healthcare providers, and members. Project Management: Demonstrates the ability to plan, organize, and execute projects effectively, managing timelines, budgets, and resources to achieve desired outcomes. Training in programs like Lean Six Sigma and Agilie. Problem-Solving Skills: Possesses strong critical thinking and problem-solving skills to identify challenges, develop innovative solutions, and implement effective strategies Interpersonal Skills: Demonstrates the ability to build and maintain strong relationships with stakeholders, including physicians, pharmacists, and other healthcare providers, to foster collaboration and achieve shared goals Regulatory Knowledge: Exhibits a thorough understanding of federal and state regulations related to pharmacy practice and pharmacy benefits to ensure compliance and mitigate risk Strategic Thinking: Demonstrates the ability to think strategically, anticipate future trends, and develop innovative solutions to address challenges and opportunities in the pharmacy benefit landscape Leadership Skills (especially for Senior Roles): Exhibits the ability to lead and influence others, providing guidance and mentorship to junior team members and driving consensus on strategic initiatives. EDUCATION Required Doctorate’s degree in PharmD or RPH degree with multiple years of experience Preferred None LICENSES or CERTIFICATIONS Required Registered Pharmacist License Preferred Licenses in Pharmacy in the Market Board Certification Pharmacy Residency or Equivalent years in the Field of Pharmacy Lean Six Sigma and Agile Certifications Masters in Healthcare Administration Additional Certifications Language (Other than English): None Travel Required: Less than 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-Based or Remote Position Physical work site required Occasionally 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. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at [email protected] California Consumer Privacy Act Employees, Contractors, and Applicants Notice Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. Highmark Health’s businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.

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