Clinical Pharmacist

This position serves as an internal and outward‑facing clinical resource responsible for quality measures supporting the pharmacy department. The role focuses on identifying Star/HEDIS measure needs, developing initiatives, and managing efforts to achieve 5 stars. It includes oversight of vendors, retail pharmacy, prime, Magellan, and health systems to deliver outcomes as outlined in various programs and reporting to internal stakeholders. Responsibilities Manage outreach efforts and pull‑through for Star/HEDIS clinical programs, coordinating between the pharmacy department, health systems, and Magellan. Drive results to obtain 5‑Stars for Medicare Part D Star clinical programs including Adherence (DM, RAS, Statins), SUPD, and CMRs for MTM. Oversee daily clinical activities related to Star/HEDIS measure goals for various health systems, ensuring clinical goals and objectives are met. Identify problems related to Star/HEDIS measures that require a clinical solution, implement and monitor clinical pharmacy solutions in support of Horizon’s Star/HEDIS goals to save money and improve care. Serve as the clinical liaison between Horizon pharmacy department and health systems, assisting with managing overall relationship and adopting recommended solutions. Develop, review and monitor clinical programs, therapeutic initiatives, pathways of care, and other drug use policies and practices in support of Star/HEDIS initiatives. Work closely with pharmacy department managers, vendors, and health systems to ensure execution of programs. Maintain continuity among health systems by communicating and documenting program design and execution in accordance with pharmacy department expectations. Track, analyze and report on patient interventions, interactions, and findings of disease management activities. With support of the Horizon data team, develop and track appropriate metrics to monitor the quality, care, and cost impact of the Star/HEDIS program and monitor overall healthcare trends within the Medicare populations. Conduct member, provider, and pharmacy outreach/interventions and Comprehensive Medication Reviews as needed to achieve Star goals. Requires communication across all departments, understanding of the strategic impact of the programs, and extensive knowledge of how Star/HEDIS programs integrate with other clinical initiatives. Understand the financial impact of all clinical recommendations: Program decisions must address impact on customers, operations, program integrity, pricing, quality, and satisfaction. Qualifications Education and Experience BA/BS in Pharmacy or PharmD. Field of study: Pharmacy. Experience 2‑5 years in a health plan or Medicare clinical customer service or retail management position. Project management experience and knowledge of health plans or Medicare industry. CMS Star/HEDIS measure quality improvement metrics. Industry Healthcare; preferably with retail or health insurance provider. Licensing and Certifications A current pharmacist license in the state of New Jersey. Knowledge CMS Star/HEDIS measures. Skills and Abilities Able to receive assignments in the form of high level objectives and independently establish detailed goals to meet objectives. Strong interpersonal skills. Excellent oral and written communication skills. Ability to function independently and as a team member. Good organization and time management, with the ability to manage multiple tasks. Proven ability to plan, organize, schedule, direct, control, and monitor project activities. Able to perform basic financial analysis. Ability to interact at a high level with external contacts. Develop reporting and tracking documents with visuals. Computer Skills Microsoft Office Suite, Access, Excel, project management, PowerPoint. #J-18808-Ljbffr