Senior Pharmacist - Strategy
Highmark · United States
- Hybrid
- Full-time
- $196,000 / year
- United States
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Job highlights
- Develop and execute drug formulary and utilization management.
- Monitor FDA approvals and drug manufacturer pipelines.
- Ensure compliance with federal and state mandates.
- Collaborate with cross-functional teams and stakeholders.
- Provide guidance to junior team members.
About the role
About the Role
Highmark is seeking a Senior Pharmacist - Strategy to join our team. This role involves monitoring FDA approvals, drug manufacturer pipelines, and drug utilization reports to develop and execute the organization's drug formulary and pharmacy utilization management policies. You will ensure compliance with federal, state, and other mandates, and potentially develop drug monographs for committee review. This position is crucial for developing and implementing management programs such as prior authorization, dose and duration edits, quantity limits, step-care edits, generic sampling, and pharmacy policy review. You will also review member-specific information to improve individual outcomes and develop educational initiatives for physicians, pharmacies, accounts, and members to promote formularies and utilization management programs. Collaboration with cross-functional committees and stakeholders is key, as is interaction with pharmaceutical manufacturers and pharmacy benefit managers to implement strategies.
Essential Responsibilities
- Formulary & Utilization Management Strategy & Development: Lead the evidence-based medicine drug evaluation program, support formulary and UM program strategy, and develop initiatives aligned with enterprise savings goals. Assist in developing drug formularies by monitoring FDA approvals, pipelines, and utilization reports, and writing monographs for committee review. Aid in developing and implementing UM programs (prior authorization, dose edits, quantity limits, step therapy, etc.) and reviewing member data for outcome improvement.
- Regulatory Compliance & Oversight: Execute the Pharmacy & Therapeutics Committee charter and ensure program compliance with regulatory standards. Support compliance related to prescription drug benefits, formularies, and pharmacy UM policies. Manage formulary administration and oversight, ensuring adherence to state and federal requirements. May represent Highmark in audits.
- Strategic Collaboration & Analytics: Partner with internal analytics teams and external vendors to generate real-world evidence for pharmacy strategy. Participate in cross-functional committees to implement clinical and operational initiatives focused on pharmacy.
- Quality Assurance & Review: Serve as a peer reviewer for medication reviews, pharmacy UM policies, and other strategy deliverables.
- Education & Communication: Develop and implement educational initiatives for physicians, pharmacies, clients, and members regarding pharmacy strategies, formularies, and UM programs.
- Project Management & Process Improvement: Identify and manage department process improvements for efficiency. Manage individual projects for timely review with leadership.
- Team Guidance & Mentorship: Provide guidance to more junior team members.
Qualifications
- Experience: 5 years of progressive experience in pharmacy, OR an accredited PGY-1 Managed Care Pharmacy Residency Program plus 2 additional years of related experience. Preferred experience in pharmacy strategy, formulary administration, or program/product development within a health system, health plan, or PBM.
- Education: Bachelor of Science in Pharmacy or Doctor of Pharmacy degree.
- Licenses/Certifications: Registered Pharmacist (Non-State Specific) required. Board Certified Pharmacotherapy Specialist or Board Certified Geriatric Pharmacist preferred.
- Skills: Understanding of managed care pharmacy principles. Strong verbal and written communication skills. Proficiency in Microsoft Office and database applications. Ability to identify and prioritize problem elements, and formulate solutions.
Working Conditions
This is an Office-Based or Remote Position. Travel is less than 25%.
Key Skills/Competency
Pharmacy Strategy, Formulary Management, Utilization Management, Managed Care Pharmacy, Drug Monographs, FDA Approvals, P&T Committee, Regulatory Compliance, Clinical Initiatives, Healthcare Analytics
Skills & topics
- Pharmacist
- Strategy
- Formulary Management
- Utilization Management
- Managed Care Pharmacy
- Drug Monographs
- FDA Approvals
- Pharmacy Benefit Manager
- Health Plan
- Healthcare Analytics
- Pharmacy
- Strategy
- Management
- Analytics
- Compliance
- Pharmacy Administration
- Clinical Pharmacy
- Healthcare
- Pharmaceuticals
How to get hired
- Tailor your resume: Highlight 5+ years of progressive pharmacy experience or a PGY-1 residency plus 2 years, focusing on strategy, formulary, and UM programs.
- Showcase skills: Emphasize your understanding of managed care pharmacy principles, strong communication, and proficiency in Microsoft Office and databases.
- Prepare for interviews: Be ready to discuss your experience in developing and implementing pharmacy utilization management programs and your ability to analyze drug data.
- Demonstrate problem-solving: Highlight your ability to identify root issues and formulate solutions, both independently and in a team setting.
- Research Highmark: Understand their C2V program and commitment to value creation in healthcare.
Technical preparation
Review managed care pharmacy principles and practices.,Study formulary development and utilization management programs.,Familiarize yourself with FDA approval processes.,Practice using Microsoft Office and database applications.
Behavioral questions
Describe a complex drug policy you developed.,How do you collaborate with cross-functional teams?,How do you ensure regulatory compliance in your work?,How do you mentor or guide junior pharmacists?
Frequently asked questions
- What are the key responsibilities for a Senior Pharmacist Strategy at Highmark?
- The Senior Pharmacist Strategy at Highmark is responsible for developing and executing the organization's drug formulary and pharmacy utilization management policies. This includes monitoring FDA approvals, assessing drug utilization reports, writing drug monographs, and ensuring compliance with federal and state mandates. The role also involves developing educational initiatives and collaborating with various internal and external stakeholders.
- What experience is required for the Senior Pharmacist Strategy role at Highmark?
- Highmark requires at least 5 years of progressive experience in the pharmacy area of specialization. Alternatively, candidates can have completed an accredited PGY-1 Managed Care Pharmacy Residency Program plus 2 additional years of related progressive experience. Experience in pharmacy strategy, formulary administration, or program/product development within a health system, health plan, or PBM setting is preferred.
- What licenses or certifications are needed for this Senior Pharmacist position?
- A Registered Pharmacist (Non-State Specific) license is required for the Senior Pharmacist Strategy role at Highmark. Preferred certifications include Board Certified Pharmacotherapy Specialist or Board Certified Geriatric Pharmacist.
- Can this Senior Pharmacist Strategy role be remote?
- Yes, the Senior Pharmacist Strategy position at Highmark can be Office-Based or Remote. The job description states 'Office-Based or Remote Position'.
- What kind of educational initiatives does the Senior Pharmacist Strategy develop at Highmark?
- The Senior Pharmacist Strategy develops and implements physician, pharmacy, client, and member educational initiatives. These initiatives promote the organization's pharmacy strategies, including formularies, utilization management programs, and other pharmacy programs, to enhance understanding and adherence.
- How does this role contribute to Highmark's goals?
- This role directly contributes to Highmark's Enterprise Customer Value Creation (C2V) program savings goals by developing pharmacy formulary and UM program initiatives. It also supports regulatory compliance and improves individual patient outcomes through optimized drug utilization.