STAFF PHARMACIST

This position is responsible for providing PrimeWest Health with consultative services related to pharmacy operations, pharmacy utilization management (UM), Medicare Part D. and as otherwise specified below. Support the Care & Population Health Management and Pharmacy teams with the following:

Utilization & Claims:

Monitor Medical Assistance and Medicare pharmacy utilization, review claims for appropriateness, and evaluate quarterly UM reports.

Compliance & Policy:

Ensure pharmacy and MTM policies meet CMS, State, and NCQA standards; monitor HPMS notifications and assist with corporate auditing.

PBM Oversight:

Serve as the secondary PBM contact, conduct annual delegation assessments and audits, and manage corrective action plans.

Clinical Review:

Perform medical necessity reviews, offer evidence-based cost analysis of drug classes, and recommend chronic disease management agents.

Quality Initiatives:

Support

HEDIS, CMS

Star Ratings, and Population Health efforts; provide clinical advice for Focused Wellness programs.

Member & Provider Support:

Perform MTM services, communicate formulary alternatives to providers, and handle weekend member calls/coverage.

Collaboration:

Coordinate with Behavioral Health (RRP/DMP), Claims, and the Universal Pharmacy Policy Workgroup (UPPW).

Communication:

Draft pharmacy newsletter articles and notify staff/members of formulary changes. A. Professional Competencies 1. Organization and time management skills 2. Ability to work effectively with minimal supervision and structure 3. Knowledge of clinical standards and outcomes 4. Ability to assess needs, establish goals, develop interventions, and conduct follow-up 5. Ability to perform critical analyses, plan and organize, and promote client and family autonomy B. Educational Requirements and Required Qualifications 1. At minimum, Bachelor of Science in Pharmacy; Doctor of Pharmacy (PharmD) preferred. UM, population health management, MTM, and managed care organization (MCO)/PBM experience beneficial. 2. Flexibility and ability to handle multiple tasks. Demonstrated organizational skills and attention to detail. Ability to work effectively with a variety of people both within and outside of the organization. Excellent verbal and written communication skills. 3. Demonstrated knowledge of, and proficiency in, Word, Excel, and Outlook required. Experience in PowerPoint is a plus. 4. Ability to sit at a desk or computer station most of the time. Ability to occasionally lift and/or carry such articles as file folders and small boxes up to 20 pounds. Some travel, including overnight travel, required. C. Appropriate Licensure and Certification Requirements 1. Must possess current and unrestricted pharmacy license in Minnesota. 2. Must attend continuing education sessions each year to support license requirement. 3. Must be certified in MTM. 4. Must be certified in CPR. Why You'll Love Working Here Not only a great job, and place to work, we also have a fantastic benefit package!

This in office/hybrid position offers:

Medical Insurance Vision Materials Coverage Long-Term Disability (LTD) Coverage Life Insurance Pension Plan (PERA) 13 Paid Holidays Vacation Bank Sick Leave Bank Volunteer Time Off Fitness Room Onsite Plus, you'll make a meaningful impact on the health and well-being of our community while working in a supportive, collaborative environment. If you're looking for a career that makes a difference in the communities we serve, we we want to meet you! Apply today!