Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:

Pharmacy Benefit Management Pharmacist will develop formulary and drug utilization management strategies that will be implemented for multiple types of patient populations. The PBM Pharmacist will create benefit designs that lead to optimal clinical outcomes while leveraging 340B eligibility, pharmacy purchase agreements and other means to achieve the most cost effective options. The PBM Pharmacist will prepare plan reviews and present to various leaders throughout the health system. The PBM Pharmacist will recommend and implement pharmacy benefit changes that will improve adherence and clinical outcomes, address inappropriate utilization and optimize drug spend.

Responsibilities:

• Coordinate formulary management including business committee decision making and implementation, oversight of formulary publications, oversight of formulary information in all provider and member materials and communications.

• Meet with plan administrators to discuss clinical trends, review relevant pharmacy data, and provide recommendations with supportive rationale for clinical and plan management strategies

• Provide consultation and recommendations regarding standard clinical program opportunities, formulary recommendations, benefit design recommendations, and other research applications and opportunities beneficial to the plan

• Manage relationship with the claims adjudicator to ensure all formularies, clinical edits and plan designs are implemented according to requirements.

• Oversee completion of prior authorization requests for members through collaboration with Prior Authorization Specialists and the claims adjudicator.

• Utilize pharmacy and medical claims data to evaluate and implement solutions to address inappropriate utilization, improve outcomes and optimize drug spend.

• Collaborate with cross-functional teams to support sales initiatives, requests for information (RFI), requests for proposal (RFP), and prospect presentations

• Provide oversight of account management team with a focus on member and client satisfaction, trend management, client retention, and regulatory compliance

• Work in partnership with the UNCHS Pharmacies to develop programs and services that benefit members and maximize the use of internal pharmacies.

• Precepts students, residents and participates in training new pharmacy staff as required.

• Complete other projects and initiatives as assigned.

Other Information

Other information:

Education Requirements:

● PharmD or BS Pharmacy Degree

Licensure/Certification Requirements:

● Active pharmacist licensure with the NC Board of Pharmacy or obtainable before initiation of employment. Recent graduates of ACPE-accredited colleges/schools of pharmacy may fill this role while pending initial pharmacist licensure, but are subject to limitations mandated by the NC Board of Pharmacy and must obtain licensure within 6 months of orientation or sooner if required for operations.

Professional Experience Requirements:

• Greater than 3 years of broad PBM and managed care experience.

• Preferred: Completion of managed care residency is strongly preferred or appropriate professional experience.

Knowledge/Skills/and Abilities Requirements:

• Strong leadership skills.

• Excellent communication skills.

• Strong organizational and time management skills.

• Ability to work collaboratively and independently.

• Perform effectively in cross-functional groups.

• Ability to lead projects and meet critical deadlines.

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: HCS Managed Pharmacy Solutions

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range: $49.75 - $71.50 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Remote

Work Schedule: Day Job

Location of Job: US:NC:Morrisville

Exempt From Overtime: Exempt: Yes

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.