Pharmacy Services Specialist

Overview

Provides analytic and clinical support related to the management of Health Plans from VNS Health Plans's pharmacy benefit programs across all business lines. Resolves problems regarding Pharmacy Benefit Manager (PBM) clinical pharmacy benefit services. Serves as a clinical pharmacy resource for clinical staff with medication management questions or pharmaceutical problems. Works under general supervision.

What We Provide:

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do:

• Assists with the preparation of pharmacy data reports and analysis that meets the planning, clinical, quality, and regulatory needs of the corporate entity and all lines of business, working with the Medical Management, Data Management, Finance Departments and clinical operations.
• Assists with the administration of Medication Management Programs, working collaboratively with other teams, including medication reconciliations and other quality pharmacy metrics driven clinical interventions in caring for older adults.
• Participates in PBM delegated services oversight role for Prior Authorization and appeals processes related to pharmacy claims.
• Participates in multidisciplinary clinical rounds by working up members' medications for potential medication related issues and serve as medication management expert for other members of the team.
• Participates in reviewing denied pharmacy claims for appropriateness of rejection and point-of-sale messaging. Leads member experience initiatives related to denied pharmacy claims to facilitate access to drugs and improve member experience with drug plan.
• Responds to, researches and resolves any problems related to member complaints regarding Pharmacy Benefit Manager (PBM) clinical pharmaceutical services.
• Participates in Quality Improvement projects; Utilization Review; Individual Drug Profile Review; and Pharmacy Standard and Protocol Development.
• Serves as a clinical pharmacy resource for clinical staff with medication management questions or pharmaceutical problems, interacting with physicians when required.
• Assists Pharmacy Services team in the development, provision and maintenance of drug research resources and other educational materials related to pharmaceutical management.
• Delivers pharmacy benefit related education and training as needed, including new employee orientation.
• Collaborates with Manager to help VNS Health Health Plans achieve goals in pharmacy related Stars targets.
• Participates in special projects and performs other duties as assigned.

Qualifications

Licenses and Certifications:

Licensed and registered in New York State to Practice as a Registered Pharmacist required. Valid driver's license or NYS Non-Driver photo ID card, may be required as determined by operational/regional needs.

Education:

Doctorate in Pharmacy (PharmD) required

Work Experience:

Minimum of two years of pharmacy experience required Experience in Medicare Part D regulations and NY State regulations for Medicaid preferred. Experience in a managed care and/or clinical care setting and geriatric pharmacy management, including experience in developing and providing professional and patient educational programs in pharmaceutical care preferred. Experience in the use and analysis of pharmaceutical data and databases preferred. Ability to use software and knowledge of Microsoft Word, Excel and Power Point required

Pay Range

USD $98,200.00 - USD $130,800.00 /Yr.

About Us

VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We're one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.