Senior Health Outcomes Pharmacist

Company :

Highmark Inc.

Job Description : 

JOB SUMMARY

The Senior Health Outcomes Pharmaicst leads the development and execution of strategic pharmacy initiatives that optimize drug spend, improve member health outcomes, and align with Highmark's overall business objectives. This role involves in-depth market analysis, collaborative program development, and proactive stakeholder engagement to identify opportunities for innovation and ensure compliance with evolving regulations. By leveraging clinical expertise and strategic thinking, the consultant drives data-informed decisions that enhance the value of Highmark's pharmacy benefit program and contribute to a more sustainable healthcare system.

ESSENTIAL RESPONSIBILITIES

• Develop and Implement Strategic Pharmacy Programs internally and in partnership with our external entity partners

• Provide Clinical Expertise and stakeholder engagement for all VBR contracts across the market

• Financial Analysis, cost management 

• Data Analysis and reporting 

• Other duties as assigned or requested.

EXPERIENCE

Required

• 5 years of experience in pharmacy practice or equivalent training (Residency)

• 5 years of Experience in managed care, pharmacy benefit management (PBM), or health plan setting.

• 3-5 years in health system consulting

Preferred (any one of the following)

• 5 - 7 years in Medicare

• 5 - 7 years in Managed Care Support

• 3 - 5 years in Quality Improvement

• 3 - 5 years in Care Management

• 3 - 5 years in Utilization Review

• 3 - 5 years in the Health Insurance Indus

• Master's Degree in Health Administration or Business

• Advance Degree in Pharmacy (Board Certification)

SKILLS

• Clinical Knowledge: Possesses a strong foundation in pharmacology, therapeutics, and disease state management to effectively evaluate medication use and inform program development.

• Analytical Skills: Demonstrates proficiency in data analysis, statistical methods, and financial modeling to identify trends, assess program performance, and inform strategic decision-making.

• Communication Skills: Exhibits excellent written and verbal communication skills to clearly and concisely convey complex information to diverse audiences, including senior management, healthcare providers, and members.

• Project Management: Demonstrates the ability to plan, organize, and execute projects effectively, managing timelines, budgets, and resources to achieve desired outcomes.  Training in programs like Lean Six Sigma and Agilie.

• Problem-Solving Skills: Possesses strong critical thinking and problem-solving skills to identify challenges, develop innovative solutions, and implement effective strategies

• Interpersonal Skills: Demonstrates the ability to build and maintain strong relationships with stakeholders, including physicians, pharmacists, and other healthcare providers, to foster collaboration and achieve shared goals

• Regulatory Knowledge: Exhibits a thorough understanding of federal and state regulations related to pharmacy practice and pharmacy benefits to ensure compliance and mitigate risk

• Strategic Thinking: Demonstrates the ability to think strategically, anticipate future trends, and develop innovative solutions to address challenges and opportunities in the pharmacy benefit landscape

• Leadership Skills (especially for Senior Roles): Exhibits the ability to lead and influence others, providing guidance and mentorship to junior team members and driving consensus on strategic initiatives.

EDUCATION

Required

• Doctorate’s degree in PharmD or RPH degree with multiple years of experience

Preferred

• None

LICENSES or CERTIFICATIONS

Required

• Registered Pharmacist License

Preferred

• Licenses in Pharmacy in the Market

• Board Certification

• Pharmacy Residency or Equivalent years in the Field of Pharmacy

• Lean Six Sigma and Agile Certifications

• Masters in Healthcare Administration

• Additional Certifications

Language (Other than English):

• None