Pharmacist

Pharmacist - Pharmacy Management

Department : Pharmacy Management

Work Schedule : Monday-Friday, 8 : 00 a.m.-5 : 00 p.m.

Position Summary

The Pharmacist in Pharmacy Management will support the mission-driven culture of high-quality performance, focusing on customer service, consistency, dignity, and accountability. This role involves drug utilization management, clinical quality improvement programs, policy development, and provider collaboration to ensure regulatory compliance and optimal member outcomes.

Duties & Responsibilities

Pharmacy Management (95%)

• Participate in a mission-driven culture emphasizing quality and accountability.
• Collaborate with the team to support departmental goals and priorities.
• Generate and analyze claims / utilization reports to identify drug utilization trends.
• Develop and update drug utilization criteria.
• Build and maintain provider relationships for successful interventions.
• Participate in medication review, disease state management, and quality improvement programs (Stars, HEDIS, MTM, interdisciplinary care teams, PACE).
• Assist in preparing drug monographs and utilization reports for the Pharmacy & Therapeutics Committee.
• Review prior authorization and appeals requests using clinical / regulatory guidelines.
• Ensure compliance with policies and regulatory standards.
• Update and develop pharmacy policies and procedures.
• Recommend and implement drug utilization intervention programs (DUR / DUE).
• Collaborate with Medical Management teams on data integration and outcomes projects.
• Review member medication profiles and provide evidence-based recommendations to providers.
• Represent the plan in state fair hearings.
• Resolve complaints, grievances, and appeals.

Minimum Qualifications

Preferred Qualifications

Required Licensure / Certifications