Pharmacist

Pharmacist

Regular

Exempt

General Description: Responsible for monitoring pharmacy utilization trends at various levels, including drug categories, prescribers, and members. This involves performing interventions with prescribing physicians and Independent Physician Associations (IPAs) to provide recommendations that encourage clinically appropriate and cost-effective treatment decisions.

Essential Functions:

• Oversee program operations, including managing vendor relationships, program updates, and deployment, to monitor and evaluate utilization changes and outcomes driven by the program and its vendors.
• Monitor the pipeline of new drugs and drug indications, assess potential utilization and financial impact, and design initiatives to control costs.
• Evaluate and monitor plans and initiatives for utilization management of assigned groups.
• Identify and evaluate members and pharmacy utilization to recognize therapeutic categories with cost-effective alternatives for treatment optimization.
• Perform interventions with prescribing physicians and Independent Physician Associations (IPAs) to identify optimization opportunities and provide cost-effective alternatives.
• Present pharmacy utilization data and initiatives in meetings with providers (Primary Care Physicians (PCP) or Specialists), IPAs, or multidisciplinary teams to highlight patient therapy optimization opportunities.
• Consider market changes and updated clinical guidelines in drug utilization evaluations and identification of alternatives.
• Participate in the development of the Department's budget and ensure expenses remain within budget.
• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

Minimum Qualifications:

Education and Experience: Doctoral Degree in Pharmacy (Pharm D). At least three (3) years of experience in pharmacy, specifically in clinical areas, either in a PBM and/or health plans.

Certifications / Licenses: A valid license and registration of Pharmacist & Association of Pharmacists of Puerto Rico is required.

Other: Knowledge of pharmacy utilization management principles and best practices. Familiarity with healthcare provider networks, including Independent Physician Associations (IPAs). Proficiency in data analysis and reporting related to pharmacy utilization and outcomes.

Languages: Spanish Advanced (comprehensive, writing and verbal) English Advanced (comprehensive, writing and verbal)

We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities.