At UPMC, we are committed to keeping our community safe and healthy as the COVID-19 pandemic unfolds. As our team continues to provide Life Changing Medicine to our patients, our recruiters will continue to fill positions throughout this time. Interviews and other processes may be modified to protect the safety of our candidates and employees. Thank you for your patience.

For more information about UPMC's response to COVID-19, please visit upmc.com/coronavirus.

UPMC Life Changing Medicine
Search Our Jobs

   Current UPMC employees must apply in HR Direct

Clinical Pharmacy Specialist

Description

UPMC Health Plan is hiring a full-time Clinical Pharmacy Specialist to support the Pharmacy Services department. This will be a Monday through Friday daylight role located in downtown Pittsburgh, Pa.

 

The Clinical Pharmacy Specialist provides clinical pharmacy expertise to the development, implementation and management of the pharmacy benefit. The clinical pharmacist assists in the management of pharmacy utilization and provides expertise in managing member care. These services will be provided in compliance with state and federal regulations, NCQA, standards, the mission, policies and procedures of Health Plan and Pharmacy Department. Individual should demonstrate professionalism and commitment to meet UPMCHP goals and objectives.



Responsibilities:

  • Administrative: Participate in meetings, committees, and work groups both internally and externally as assigned. Maintain a solid understanding of the requirements of the Pennsylvania Department of Health, DPW, CMS and the National Committee for Quality Assurance, specifically as they relate to the expectations of pharmacy operations. Ensure compliance with regulatory and accreditation requirements of clinical functions.

  • Clinical Activities: Develop and revise various formularies for each line of business (commercial, Medicare, Medicaid), including sending communications, training of identified departments, updating all brochures, updating the website, and submitting change forms. Research adequately and be properly prepared for all P&T Committee meetings, ensuring all recommendations for both new drugs and new policies are appropriate and have been discussed with subject matter experts. Present these assignments succinctly and at a suitable pace, volume, and speed and answer all questions. Develop and conduct Drug Utilization Review (DUR) activities, Medication Therapy Management (MTM), and other integrated programs with medical management. Create, develop, maintain and enhance clinical reporting programs, including but not limited to physician specific reporting, alternative prescribing programs for utilization, assigned client plans, etc. Manage and evaluate therapeutic drug interventions and other clinical pharmacy programs for the purpose of controlling pharmacy trend, including member and provider interventions, and looking specifically at outcomes for these programs, as well as considering comprehensive research projects. Pipeline monitoring and evaluation. Provide innovative and applicable ideas in clinical program development, utilization management, formulary management, provider education, therapeutic substitution, MTM/DUR, and/or improvements in programs and edits that already exist, including both improving operational efficiencies, as well as developing new clinical edits. Implement these new ideas or improvements as approved, while also considering outcomes in all programs. Work with employer clients, account management, and sales in client and member meetings as assigned to improve the understanding of the pharmacy benefit, as well as offering recommendations.

  • Communication: Foster and maintain collaborative relationships with internal and external customers. Communicate pharmacy information as appropriate to members, employer groups, and providers. Develop communication materials to providers, including discussions regarding formulary changes/adherence, health education, medication compliance, and trend management.

  • Operational Activities: Critically review of medication based prior authorization requests for approval/denial against standard criteria. Review and participate in member appeal cases, including hearings. Support the pharmacy call center by answering the phone queue to assist call representatives. Review new drugs in a timely manner and submit change forms as appropriate.

  • Special Skills/Ability to Interact: Have ability to function independently, but support team concept. Behavior denotes reliability as demonstrated by prompt attendance and timeliness completing designated workload and follow-up. Conveys and maintains professional image while interacting with coworkers, providers and clients. Honor client and patient confidentiality. Performs in accordance with system-wide competencies/behaviors. Performs other duties as assigned.

  • Teaching and Education: Mentor students, and assist in precepting for the residency program.

 

Qualifications

  • Bachelor of Science Degree in Pharmacy, and/or Doctor of Pharmacy Degree (Pharm.D.) from an accredited U.S. School of Pharmacy.
  • Experience in pharmacy benefit management, insurance, managed care preferred and be knowledgeable in therapeutic interventions and other cost containment programs.
  • Effective communication skills, both written and oral.
  • Must have strong analytical ability and organizational skills.
  • Computer literacy for pharmacy programming, word processing, data management.
  • Assessment of job related skills and competency will be reviewed annually via daily functioning, job-related documentation, department based competency programs, and continuing education activities.

Licensure, Certifications, and Clearances:
Registration as a registered pharmacist (RPh), in the Commonwealth of Pennsylvania or eligibility for licensure by examination or reciprocity.
Continuing Education requirements met each bi-annual cycle for re-licensure, as evident by obtaining a minimum of 30 hours of continuing education every 2 years in structured pharmaceutical education as necessary by the state board

  • Pharmacist



  • UPMC is an Equal Opportunity Employer/Disability/Veteran

    Total Rewards

    More than just competitive pay and benefits, our Total Rewards package cares for you in all areas of life. Designed to help you achieve your goals, Total Rewards support our belief that you’re at your best when you’re receiving the support you need in all areas of life: professional, personal, financial, and more.

    Our Values

    No matter where we work or what we do, we’re driven by common values that guide our work and keep us accountable to one another. UPMC’s values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive, experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

       Current UPMC employees must apply in HR Direct

    Talent Network