Pharmacy Resident

Company :

Highmark Inc.

Job Description : 

JOB SUMMARY

This job is responsible for the unique environment that grants exposure to a multifaceted approach to managed care pharmacy, including clinical management, sales, operations, and scholarly activities.  The incumbent is an integral part of the clinical team and will participate in virtually all of the daily clinical activities and operations as the full-time pharmacists, such as performing clinical reviews, policy writing, formulary updates, and Medication Therapy Management for Medicare Part D.  Presents professional posters at a national meeting of managed care organizations and/or publish articles in peer-reviewed professional journals. Required and elective rotations will provide the resident with exposure to diverse experiences such as specialty pharmacy, sales and marketing, regulatory and compliance, contracting and manufacturer relations, Senior Products, journal clubs, new drug presentations, direct patient care, and various teaching opportunities.
 

ESSENTIAL RESPONSIBILITIES

• Develop exceptional written and verbal communication skills, demonstrated through daily professional interactions; preparing provider, member, and group communications; oral presentations; poster presentations; and/or article publication.
• Oversee day-to-day operations of the drug utilization review (DUR) initiatives within the Medical and Pharmacy Affairs department, including reviewing cases and consulting with internal and network physicians.   
• Develop policies related to new DUR initiatives as well as communications to disseminate the information to members, network providers, and internal staff.  
• Develop a detailed understanding of the managed care business and the potential roles of pharmacists within the managed care setting.
• Perform an evaluation of both a new medication as well as a class review based on efficacy, safety, unique value, and cost parameters utilizing drug information skills.
• Gain an understanding of regulatory and legislative issues impacting the health care industry with a focus on managed care.
• Conduct rotations in areas including Specialty Pharmacy, Sales and Marketing, and Manufacturer Relations and Contracting to include
• Identify market trends and changes in utilization, in order to propose new prescription drug benefit changes to help manage the rising costs of healthcare.
• Participate in patient care activities including case management rounds and Medication Therapy Management. Review member’s prescription drug claim profile and make accurate and meaningful suggestions for improvement.
• Conduct research and prepare documents that will be used by committees  of the Organization to determine Formulary status of medications, as well as any strategic management programs that could apply to individual drugs or entire classes of medications.
• Gain an understanding of prescription drug benefit design, including an understanding of the formulary process and components of different types of formularies (open, closed, multi-tiered).  
• Develop criteria used to evaluate a request for non-formulary drug coverage, evaluate a prior authorization request, or evaluate a managed prescription drug coverage request.
• Participate in the clinical evaluation process for determining whether coverage for non-formulary medications and/or prior authorizations will be approved.
• Gain an understanding of the benefit consultant’s role in evaluating trends in current benefit structures and opportunities for managing benefits.
• Participate in journal club, research projects, and seminar presentations either on-site at Highmark or at the University of Pittsburgh.
• Medicare Part D file management and  Pipeline drug database management.
• Other duties as assigned or requested.

EDICATION

Required 

• Doctor of Pharmacy (PharmD)

Substitutions

• None

Preferred

• None

EXPERIENCE

Required

• None

Preferred

• Retail, Hospital, or other Pharmacy experience preferred
• Strong computer skills including word processing, spreadsheet and database end user experience as well as strong verbal and written communication skills

LICENSES AND CERTIFICATIONS

Required

• Licensed pharmacist in Pennsylvania, licensure pending successful completion of Pennsylvania State Board Exam, or ability to reciprocate license.  Must be licensed in Pennsylvania no later than October 31 of the year the position is started

Preferred

• None

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

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