Job Description

CORE VALUE COMMITMENT:

In common mission, our teams work together with our patients at the center. We strive to continuously improve. We value one another’s diversity of talent, experience, and perspective. We each contribute to something bigger than ourselves while promoting integrity, belonging, and collaboration.

JOB SUMMARY:

The Pharmaceutical Care Pharmacist works with physicians, care managers, and other clinical staff as part of a care team focusing on patient outcomes and managing all aspects of patient medication therapy, while maintaining or lowering costs and providing high quality of care. This role assists the physician teams to comply with the accountable care organization measures, working within their scope of practice to manage patient’s medications and working toward improving patient outcomes by providing patient-centered quality of care. This role will partner with parent company BCBSNE to develop and implement management strategies of BCBSNE MA members to positively impact BCBSNE STAR ratings, cost containment, clinical outcomes, and patient satisfaction.

ESSENTIAL JOB FUNCTIONS:

• Collaborate with physicians to create and manage drug regimens for chronic disease states (e.g., diabetes, asthma, CHF). Conduct patient consultations, adjust medications per PCP guidance, and monitor clinical indicators such as blood pressure and blood sugar. Perform medication reconciliation assessments and coordinate referrals to internal services (behavioral health, care coordination, etc.).
• Provide Comprehensive Medication Reviews (CMRs) and counsel patients on medication use and device handling (e.g., inhalers, glucose monitors, insulin injections). Create and follow up on medication action plans, ensuring evidence-based and cost-effective regimens. Collaborate with PBMs and internal stakeholders to support MTM and CMR completion activities.
• Oversee clinical pharmacy technicians in processing pre-authorizations and refill requests.
• Participate in population health initiatives targeting chronic conditions to improve medication outcomes. Analyze drug utilization patterns to inform clinical decisions and improve patient outcomes. Support internal care management processes and outreach efforts for at-risk members.
• Collaborate with pharmacies to manage drug tiering and utilization, ensuring cost-effective and clinically appropriate options.
• Develop strategies to increase generic dispensing and reduce overall healthcare costs.
• Partner with PBMs to implement cost containment strategies and outreach initiatives.
• Work with ACOs, physician offices, and health plans to promote best prescribing practices.
• Address non-compliance with adherence measures (e.g., statin therapy for ASCVD/diabetes, PolyACH, COB).
• Provide timely outreach to members, avoiding premature contact that may cause member frustration or disengagement.
• Assist members in understanding medication options and collaborate with PCPs to identify cost-effective alternatives.
• Respond to patient inquiries regarding prescriptions.
• Serve as a drug information resource for providers and support staff.

KNOWLEDGE, SKILLS & ABILITIES:

• Knowledge of prescriptions, medications, and clinical pharmacy procedures/best practices.
• Knowledge of HIPAA and other privacy regulations.
• Proficiency in using computers and software including Electronic Health Records (EHR), Microsoft Word, Excel, Access, and Outlook.
• Strong verbal and written communication skills.
• Ability to manage multiple priorities effectively.
• Professional demeanor when engaging with patients, maintaining privacy and confidentiality.
• Ability to enter and manage data accurately in electronic systems.
• Ability to follow oral and written instructions.
• Ability to work independently and collaboratively within a team.
• Ability to represent the organization positively and professionally.

EDUCATION & EXPERIENCE:

Pharm D degree from an ACPE accredited institution or Bachelor’s degree in Pharmacy required. Current NE Pharmacy License in good standing required. PGY1 in Pharmacy Practice (Ambulatory Care focus) or PGY1 in Community Pharmacy residency, fellowship,

or equivalent clinical experience preferred. Board Certification, prior Electronic Health Record experience and QS/1 System experience preferred.

Think Whole Person Healthcare is an Equal Opportunity Employer

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