Health Plan Pharmacist
Company: MEDSTAR HEALTH
Location: Washington
Posted on: March 16, 2025
Job Description:
General Summary of PositionWe are actively recruiting for a
Health Plan Pharmacist to join MedStar Family Choice in Washington,
DC. - This position is primarily day shift with some on-call
responsibilities. - This position requires the selected candidate
to work in the DC office 4 days a week with 1 remote day a week
allowed.The Health Plan Pharmacist manages all aspects of the
Pharmacy Program for the health plan including but not limited to:
review of all requests for medications requiring prior
authorization or other exception; management of the content of the
formulary for appropriateness and financial efficiency;
preparation, execution, and implementation of Pharmacy and
Therapeutics Committee activities and decisions; internal and
external reporting; medication therapy management; management of
safety recalls in conjunction with the Pharmacy Benefit Manager;
creation, implementation, and management of projects related to
quality and safety, including Drug Utilization Review (DUR)
initiatives; and attendance and participation in meetings with
government entities. This position serves as the designated key
personnel to the Department of Health Care Finance (DHCF) for all
pharmacy related matters and will be anchored to the health plan
operations in the District of Columbia. This position has
responsibility for Maryland pharmacy operations as well.
We recruit, retain, and advance associates with diverse
backgrounds, skills, and talents equitably at all levels.
Primary Duties and Responsibilities
- Reviews pharmaceutical requests for formulary medications
requiring prior authorization, non-formulary requests, and other
medical exceptions.
- Provides consultations with prescribers as needed related to
pharmacy requests and formulary guidance.
- Provides analysis and insights into decisions regarding the
Health Plan closed formularies for medications with attention to
costs.
- Analyzes financial performance and makes recommendations for
changes to the formulary to MFC Managers and the Pharmacy and
Therapeutics Committee.
- Prepares and submits all required reports to the Maryland
Department of Health (MDH) and the District of Columbia Department
of Healthcare Finance.
- Manages all aspects of the operation of the Pharmacy and
Therapeutic Committee including, but not limited to, preparation,
execution, and implementation of Pharmacy and Therapeutics
Committee activities and decisions.
- Develops and manages DUR projects in accordance with
governmental/jurisdictional requirements.
- Identifies the need for, develops, and manages new and existing
Health Plan-initiated Drug Utilization Review projects.
- Maintains Pharmacy Policies and Procedures in compliance with
NCQA, COMAR, MDH Pharmacy Standards, District of Columbia Contract
and District of Columbia Health Care Finance Administration
Pharmacy Division.
- Responsible for tracking updates, communicating, and
maintaining compliance with additional pharmacy requirements as
they are provided by MDH and District of Columbia Health Care
Finance Administration Pharmacy Division.
- Works collaboratively to communicate formulary policies,
procedures, and changes to enrollees and practitioners with
Outreach, Enrollee Services, Provider Relations, and Health Plan
Communications Departments via written letters, newsletter
articles, fax messaging, website updates, and other means.
- Collaborates with Pharmacy Benefit Manager for market
withdrawals, FDA recalls, and other quality and safety outreach
efforts.
- Evaluates situations of potential Fraud, Waste and Abuse if
requested by the Compliance Department.
- Provides Medication Therapy Management to enrollees by
assessing individual enrollee medication regimens with a focus on
interactions, adherence, and patient issues (social determinants of
health) with resultant recommendations for optimal medication
therapy. Able to effectively convey recommendations to relevant
prescribers.
-
Minimum Qualifications Education
- Bachelor's degree in Pharmacy or PharmD required and
- Post Graduate Year (PGY)1 required or equivalent experience
required
Experience
- 3-4 years Pharmacist experience in ambulatory clinical practice
or managed care setting required
- Completion of ASHP-accredited residency in managed care
pharmacy or ambulatory care preferred
Licenses and Certifications
- Licensed in the District of Columbia and Maryland required
- If licensed in only one jurisdiction, application for licensing
in the other jurisdiction must be submitted within in 30 days of
MedStar start date
Knowledge, Skills, and Abilities
- Effective verbal and written communication skills.
- Excellent interpersonal and customer service skills especially
serving underprivileged populations.
- Teaching skills to promote healthy behavior change.
- Strong analytical and critical thinking skills.
- Flexibility and the ability to work autonomously as well as
take direction as needed.
- Cultural competency.
- Proficient computer skills along with experience using
Microsoft applications-Word, Excel, etc. and familiarity with
entering data in an electronic medical record (EMR).
This position has a hiring range of $100,588 - $190,340
-
Keywords: MEDSTAR HEALTH, Washington DC , Health Plan Pharmacist, Healthcare , Washington, DC
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