Utilization Management Assistant Jobs in Maryland

Resp & Qualifications

PURPOSE: 
The Clinical Pharmacist will perform comprehensive clinical services involving oversight of clinical programs and processes to comply with program guidelines and requirements. Responsibilities will include but not are limited to; drug formularies, utilization management, clinical drug evaluations, development of drug management tools, and oversight of delegated programs. The Clinical Pharmacist may also perform patient education, medication counseling, drug therapy monitoring, and chronic disease state management for patients in clinical programs. 
ESSENTIAL FUNCTIONS:

• Tracks productivity, quality, impact, and overall performance of clinical pharmacy programs, formularies, and/or utilization management. Identifies areas where program modifications could result in improvements to patient outcomes and reduce costs. Works collaboratively with vendors, PBMs, and internal parties for oversight of programs and performance management.
• Performs data collection of members to identify referrals for clinical pharmacy programs as well as telephonic therapeutic consultations to patients and/or prescribers. Completes a pharmacotherapy assessment of patient's claims, past medical history and disease states. Provides clinical recommendations pertaining to, but not limited to, adverse events, therapeutic duplication, adherence to therapy, polypharmacy, high risk medications, therapeutic substitution, and untreated disease or conditions. Utilizes formulary information and member specific benefits to guide appropriate medication recommendations. Develops a plan of care that details actions of the patient and/or prescriber based on the Pharmacotherapy assessment.   
• Develops and provides formal written and verbal presentations or other communication materials related to clinical pharmacy programs, pharmacy utilization, pharmacy strategy, and pharmacy topics to a broad audience including both internal and external stakeholders.   
• Assesses value of 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. 
• Reviews pharmacy market information and trends to develop and coordinate the implementation of appropriate strategies or programs for cost containment and clinical management.

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

Licenses/Certifications Upon Hire Required:

• PHARMD - Licensed Pharmacist Direct Patient Care -  Active Registered Pharmacist in Maryland and/or DC or
• PHARMD - Licensed Pharmacist No Direct Patient Care -  Active Registered Pharmacist in any state and/or DC

Experience: 5 years' experience in clinical pharmacy, preferably in a managed care environment.
Preferred Qualifications:

• Experience in Medicare and/or 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 required.
• 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: 120,240 - 214,929

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 responsibilities 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).

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.

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 Federal 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

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