Clinical Pharmacist
Location
Maryland
Posted
6 days ago
Salary
$135K - $165K / year
Seniority
Senior
Job Description
Clinical Pharmacist
Gainwell Technologies
• evaluate prescription claims data • develop and present clinically driven recommendations and initiatives • evaluate utilization management criteria and operational impact • support and maintain configuration requirements • research policy and regulatory drivers • coordinate with operations, claims, network, reporting, and other internal stakeholders • analyze clinical, utilization, prescribing, claims, and pricing data • develop, implement, manage, and evaluate utilization management programs
Job Requirements
- Licensed Pharmacist
- minimum of five (5) years of experience in pharmacy benefit management or pharmacy managed care
- detailed knowledge of Medicaid programs at both state and federal levels
- ability to communicate succinctly and accurately in both written and verbal English across diverse audiences
- experience presenting complex clinical findings, recommendations, and program outcomes to senior leaders
- experience evaluating healthcare data, clinical outcomes, quality measures, and performance metrics
- demonstrated experience applying population health principles to improve medication use, quality outcomes, and healthcare delivery
- strong PC skills with advanced proficiency in Microsoft Office, data analysis, project management, problem-solving, and virtual collaboration platforms
Benefits
- comprehensive health benefits
- flexible vacation policy
- 401(k) employer match
- educational assistance
- leadership and technical development academies
Related Guides
Related Categories
Related Job Pages
More Pharmacist Jobs
Senior Manager – Oncology & Rare Disease Products
CVS HealthCVS Health is a leading healthcare company operating CVS Specialty, CVS Pharmacy, CVS MinuteClinic, and CVS Caremark. In 2018, CVS combined forces with healthca
• Responsible for driving growth in Specialty by building innovative products • Develop robust product roadmap based on current and anticipated market trends • Collaborate across the organization to deliver new solutions to market • Build and execute product roadmap that solves payor, provider and patient needs • Leverage pharmacist expertise to inform clinical strategy and performance • Assist in the development of tools and processes to improve effectiveness • Collaborate with external partners to develop strategies for managing high-cost medical drugs
Coverage Review Pharmacist
BlueCross BlueShield of TennesseeBringing peace of mind through better health to our customers and communities
• Perform prospective and retrospective coverage reviews and appeals per State and Federal regulations. • Serve as a clinical resource to aid in solving basic to mid-level reviews with limited assistance and supervision. • Maintain denial rationale associated with clinical criteria and ensure that decision letters meet regulatory compliance and guidance. • Participate in alternating team on-call rotation.
Part-Time Staff Pharmacist
The Cigna GroupAt The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers, and patients. Join us in driving growth and improving lives.
• Complete remote order entry, order verification, and drug verification • Provide patient counseling when needed • Navigate multiple pharmacy information systems (PIS) • Provide drug information and therapeutic guidance to providers • Assess medication appropriateness, dosing (including renal/hepatic adjustments), interactions, and compatibilities • Support specialized populations such as pediatrics, geriatrics, pregnant/nursing patients, HIV, and those with renal/hepatic impairment • Maintain knowledge of IV therapies, TPN, cardiac/narcotic drips, IV antibiotics, chemotherapy, and more • Document interventions and clinical actions accurately and promptly • Communicate effectively with physicians, nurses, and patients • Ensure compliance with HIPAA, pharmacy laws, and client policies • Work across VPNs, automation systems, and multiple PIS platforms • Use applications such as Google Suite/Microsoft Office and Snagit • Maintain required licenses, credentials, and system access • Participate in ongoing training (clinical, PIS, and policy updates) • Meet productivity and quality standards
Care Management Pharmacist
Evergreen NephrologyEmpowering nephrologists to transform kidney care and improve patient outcomes
• Consult directly with patients, their caregivers, and other members of their care team to implement Evergreen’s comprehensive pharmacy care management programs, including medication reconciliation, patient education, and collaboration with the patient’s care team to resolve medication concerns. • Utilize principles of Comprehensive Medication Management (CMM) to optimize all clinical aspects of medication therapy regimens, considering effectiveness of medications, identify unnecessary drug therapies, incomplete immunization records, medication safety, adverse effects, renal dose adjustments, and other contraindications. • Engage in patient outreach and consultation to support real-world adherence with the medication plan of care, integrating best practice techniques for behavior modification, to optimize patient health outcomes. • Drive medication-related clinical quality initiatives, including GDMT optimization and adherence improvement, by identifying gaps, designing targeted interventions, and partnering with care teams to improve patient outcomes and performance against value-based quality measures. • Participate in medication safety initiatives to minimize use of nephrotoxic medications among our CKD patient population and address other high-risk medication use with a holistic, patient-centered approach. • Support appropriate medication use across the continuum of care, focusing on the post-hospital discharge period, to ensure patients accurately implement the medication plan. • Seek alternatives as necessary to ensure the best care is provided that will maximize clinical outcomes, ensure equitable access to medications, and support appropriate levels of financial spend. • Analyze and recommend cost-savings strategies based on plan formularies, insurance phases, and evidence-based chronic disease management guidelines. • Act as an internal subject matter expert, developing and delivering education to patients, caregivers, and internal Evergreen teams regarding medications and chronic disease states. • Other duties consistent with this role, as assigned.




