Pharmacist - Case and Disease Management (CMDM)

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job works as part of a product-line specific (MA, ACA, Commercial) multi-disciplinary team to close gaps in care for high-risk members. Through the multi-disciplinary team, patients who have high risk gaps in care related to medication therapy are transitioned to a Pharmacist for Case & Disease Management (CMDM). The incumbent then conducts thorough research to evaluate the patient and extensive clinical judgement and discretion to provide recommendations for closing the gap in care. The incumbent may interact with the patient or care giver, physician, and/or pharmacist through the intervention.

ESSENTIAL RESPONSIBILITIES

• Review gaps in care for high risk patients ​ss part of a multi-disciplinary team. Conduct research including gathering claims data, reviewing clinical websites, etc. to thoroughly evaluate each patient's unique situation to provide the appropriate clinical recommendation.

• Contact patients, care givers, physicians, pharmacists, etc. to intervene on identified gaps of care using a high level of clinical judgement and discretion.

• Other duties as assigned.

EDUCATION

Required

• Bachelor's Degree in Pharmacy

Substitutions

• None

Preferred

• Doctorate in Pharmacy

EXPERIENCE

Required

Required experience can be reduced from 3-5 to 1-2 years if the candidate completed a clinical residency program

• 5 - 7 years in Pharmacy

• 3 - 5 years in Pharmacist - Utilization Management

• 3 - 5 years in Pharmacist - Medical Therapy Management

Preferred

• None

LICENSES AND CERTIFICATIONS

Required

• Registered Pharmacist

Preferred

• None

SKILLS

• Oral & Written Communication Skills

• Telephone Skills

• Problem Solving & Decision Making

• Compliance

• Collaborative Problem Solving

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$118,400.00

Pay Range Maximum:

$196,800.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

About Us

Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network.

Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services.

Highmark Health’s businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.