Health Outcomes Pharmacist

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🔥 20 minutes ago

🏈 Ohio, Maryland, +3 more states – Remote

🏈 Ohio – Remote 🦀 Maryland – Remote 🔔 Pennsylvania – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

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WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

⚕️ Healthcare Insurance

Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 Description

• Optimize medication use for members with complex conditions or chronic diseases and reduce total cost of care • Conduct medication reviews, identify drug therapy problems, and collaborate with providers and care managers on appropriate interventions • Partner with care management, disease management, and interdisciplinary care teams to support medication optimization and achieve desired health outcomes • Contribute to the development and implementation of member care plans, especially for high-risk or high-cost populations • Serve as a subject matter expert for pharmacy benefits, including formulary, prior authorization, and step therapy protocols • Respond to pharmacy-related inquiries from providers, members, and internal departments to ensure clarity and appropriate benefit utilization • Support initiatives related to HEDIS, CMS Star Ratings, and other quality performance metrics involving medication use • Identify and address gaps in care through targeted outreach and interventions • Educate providers on formulary changes, prescribing best practices, and opportunities for improved medication utilization • Conduct member outreach as needed to support medication understanding, adherence, and wellness • Ensure compliance with state and federal regulations related to pharmacy services, including Medicare Part D and Medicaid guidelines • Assist with reporting and documentation to support audits, accreditation, and internal reviews • Analyze pharmacy and medical claims data to identify trends, risks, and opportunities for improvement • Track and report on clinical outcomes, program impact, and performance benchmarks • Participate in the design and execution of pharmacy-related quality improvement programs and pilot projects • Contribute to the continuous improvement of pharmacy and care coordination services across the organization • Engage in relevant boards, committees, task forces, and organizational meetings, as well as other designated activities • Licensure in multiple states may be required, depending on evolving business needs and regulatory requirements • Perform other related duties and responsibilities as assigned

🎯 Requirements

• Must possess current license as required by state board where services will be provided • Three (3) years experience working in a managed care, health plan, or population health environment • Three (3) years proven experience with quality measurement programs including HEDIS, Stars Ratings, and Medicare Advantage and Medicaid regulations • Three (3) years in clinical pharmacy practice • Managed Care Residency, Ambulatory Care Residency, OR Board Certification in Pharmacy specialties such as Board Certified Pharmacotherapy Specialist (BCPS), Board Certified Ambulatory Care Pharmacist (BCACP), or Board Certified Geriatric Pharmacy (BCGP) • In-depth knowledge of Medicare Part D and Medicaid pharmacy benefits • Experience collaborating with interdisciplinary care teams, case managers, and providers to optimize medication use • Experience in Medication Therapy Management (MTM), proficiency in utilizing MTM platforms and tools • Proficiency with electronic health records (EHR) systems, such as EPIC

🏖️ Benefits

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development