Health Plan Pharmacist

Navitus - Putting People First in Pharmacy

Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities.

Compensation & Remote Work

• STAR Bonus % (At Risk Maximum)
• M-F 8am to 5pm Remote Work Notification
• Navitus is only able to offer remote work to residents of Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Washington DC, Wisconsin.

Responsibilities

• The Pharmacist, Population Health will be responsible to perform duties related to the development, implementation, outcomes reporting, and ongoing administration and support of Navitus Clinical Programs including Drug Utilization Review (i.e., RDUR, CDUR), Health Management (i.e., clinical edits, Asthma Management, COPD Management, Pharmacogenomics, Pharmacoadherence, Prescriber Insights, MTM), and other strategic clinical initiatives (i.e., The Pharmacist, Population Health will also provide support to other clinical areas including Account Management, Lumicera, Drug Information and Pipeline, and the Pharmacy and Therapeutics (P&T) Committee.
• The Pharmacist, Population Health is responsible for reviewing, evaluating, and sharing the health outcomes and utilization data for program management and development.
• The Pharmacist, Population Health will develop and maintain appropriate clinical, evidence-based documentation that supports PBM programs.
• The primary functions involve ensuring that Navitus can provide clinically sound programs (including products, edits, and reports) in the most cost-effective manner and utilize technology to implement clinical programs. This utilization of technology frequently involves translation between technical guidelines and clinical program business requirements as well as program testing.
• Provide clinical outreach to members, prescribers, and pharmacy providers to enhance care coordination.
• Provide support to operational departments on the implementation of various PBM programs and daily functioning in support of member/patient quality of care.
• Have strong knowledge of various standards, regulations, and guidance including Medicare Part D, PQA, and HEDIS measures and concisely communicate that information to stakeholders and clients.
• Provide leadership, training, supervision, and strategic direction to Product Managers.
• Participate in the Coverage Determination (Certification, Prior Authorization, Medical Exception, Exception to Coverage, etc.).

Qualifications

• Bachelor’s degree in Pharmacy or PharmD required.
• ~ 2+ years of clinical experience, or clinical or managed care pharmacy practice residency and 1-year clinical experience.
• ~ Knowledge of PBM industry, formulary management, pharmacy claims and managed care principles and practices desired.
• ~ Proficiency in drug literature and clinical trial evaluation, including proficiency with electronic databases (e.g., Proficiency in MS Word, Excel, PowerPoint including tables, charts and figures preferred.

Benefits

• ~ Top of the industry benefits for Health, Dental, and Vision insurance
• ~9 paid holidays
• ~Adoption Assistance Program
• ~ Flexible Spending Account
• ~ Educational Assistance Plan and Professional Membership assistance
• ~ Referral Bonus Program – up to $750!

Remote Location

#LI-Remote

Remote Location : Country