Pharmacist, Clinical Programs - Hybrid

Summary of Job

Act as collaborator or point for the integration and oversight of pharmacy programs with enterprise-level initiatives in quality, care and utilization management, using digital tools. Design and manage strategic projects, including supporting business case development, PMO, and coordination across teams. Collaborate with VP, Pharmacy, pharmacy and lines of business product owners to maintain alignment across medical and pharmacy products, including PDP. Coordinate with operations team as needed for client benefit intent management. Lead and support Clinical, Care Management and Quality teams across multiple lines of business as assigned. Key contact for delegation oversight of vendors and related programs for the pharmacy department. Contribute to the overall success of Pharmacy Programs by promoting /advancing the department mission of effectively managing members and improving program outcomes. Coordinate with EH Enterprise quality team to oversee and drive clinical programs outcomes and ROI monitoring (e.g., non-NYC MTM, targeted programs for GLP-1, Obesity, diabetes, etc.)

Responsibilities

• Serve as a clinical subject matter expert (SME) for medication-related care management strategies, integrating pharmacy insights into holistic member care plans across lines of business.
• Drive integration of pharmacy data into care management workflows, leveraging analytics to identify gaps in care, adherence risks, and intervention opportunities.
• Identify and stratify high-risk members using pharmacy and medical data to prioritize care management interventions. Support utilization, monitoring, and cost management of high cost/specialty members/drugs.
• Support training and upskilling of care management staff on pharmacy-related topics, including drug trends, adherence barriers, and therapeutic updates.
• Participate in care management and interdisciplinary team meetings to share insights and recommendations.
• Educate pharmacy and internal EmblemHealth staff to understand pharmacy concepts and programs that effectively contribute to managing members with chronic health conditions.
• Educate business partners on the development of new pharmacy offerings including design, development of project plans, leading meetings, and implementation of innovative programs and processes.
• Actively participate in vendor presentations and meetings to help identify, develop, and maintain project progress.
• Interface and work collaboratively with key departments and other healthcare vendors.
• Develop methodologies for pharmacy program assessment inclusive of ROI and proof points of program outcomes.
• Monitor and improve program effectiveness to meet program and departmental goals.
• Actively participate in delegation oversight with multiple Pharmacy services vendors to ensure company and regulatory compliance. Review and triage single case agreements needs to the Operations team for execution.
• Oversee Comprehensive Medication Reviews (CMRs) and Medication Reconciliations as part of Commercial and Medicare pharmacy support for members.
• Coordinate with vendors to oversee metrics, performance, and ensure appropriate member experience.
• Oversee regulatory material review and develop improvements for leadership review.
• Support NCQA and other regulatory requirements that are applicable to pharmacy programs.
• Effectively partner with leadership to continually advance our programs.
• Support marketing activity and other corporate objectives.
• Perform related tasks, duties, and special projects as directed, assigned, or required.