HEDIS/NCQA.

The incumbent possesses good clinical/analytical skills and sound decision-making capabilities to identify opportunities/risks and propose benefit program quality/utilization management strategies accordingly. Strong interpersonal and excellent communication skills are essential due to interaction with various members of the medical profession, managed care clients, and external organizations. Responsibilities and Qualifications Formulary management including drug evaluation, P&T Committee, and related physician and member collaterals Pharmaceutical utilization and trend management via pharmacy clinical initiatives PBM vendor clinical services and programs oversight Specialty pharmaceutical management Pharmacy clinical and utilization management criteria, protocol, policies, and procedure development Provide clinical and drug information support Maintain regulatory including Medicare Part D, and accreditation compliance Develop member and provider educational programs Conduct presentation and training Maintain provider and pharmaceutical industry/drug manufacturer relations. Staff supervision

Skills:

Strong interpersonal and team skills with ability to work and interact externally and internally. Ability to communicate effectively with varied audiences, including ability to lead meetings, develop teamwork, and deliver verbal presentations. Ability to take direction from various levels of staff and perform project work with minimal supervision. Strong clinical/analytical skills and decision-making capabilities required. Strong interpersonal and excellent communication skills required. Ability to assess utilization data to identity new opportunities.

Knowledge:

Managed care knowledge and experience preferred. In-depth knowledge of drug formulary systems and drug evaluation process. Broad knowledge of outpatient drug benefit and utilization management programs. Knowledge of pharmacy claims processing along with applicable state/federal laws. Knowledge and experience with Medicare Part D and NCQA accreditation preferred. Knowledge and experience with therapy medication and disease state management. Possess working knowledge of medical and pharmacy data integration to close gap in care and facilitate greater care coordination.

Experience:

Experience in developing pharmacy clinical protocol, policies, and procedures. Experience in design/deployment of programs to increase quality of care and decrease costs.

Education and Certifications:

Pharmacy degree and current Pennsylvania pharmacy license required. Advanced pharmacy degree (Masters or Pharm.

D.) preferred.

Location:

This position is classified hybrid, which requires onsite work on Tuesdays and Wednesdays.

Work Environment:

Working environment includes typical office conditions.

Physical Demands:

While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must be able to work over 40 hours per week. The employee must occasionally lift and/or move up to 5 pounds. Sedentary work involving significant periods of sitting, talking, hearing, keying and performing repetitive motions. Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor.

Other:

Performs other related duties and assignments as directed. Travel less than 1%. Occasional overnight travel and travel between CBC locations. About Us We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. 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Clinical Pharmacist - PBM