Health Outcomes Pharmacist

Job Opportunity At Highmark Inc. Job Summary: This job is directly responsible for the value creation, impact and cost control, and fiscal/ROI targets as set by the organization. This includes revenue stream outcomes and engagement of primary care providers (PCP) and facilities enrolled in the organization's value based reimbursement programs, clinical care models, and continuous improvement models. The incumbent applies subject matter expertise in clinical pharmacy, pharmacy formulary, pharmacy benefit design, pharmacy policy, medical drug policy, therapeutic alternatives, medication adherence strategies, Medication Therapy Management, utilization management, immunizations, specialty pharmacy, Medicare Stars, and Medicaid HEDIS to strategies designed to promote the organization's value based reimbursement PCP and facility programs. Essential Responsibilities: Serve as the Clinical Pharmacy SME and support broader CTC team in pharmacy related report interpretation and assist in the development of strategies for PCPs and facilities that promote the organization's value based reimbursement PCP and facility programs. Provide office based, hands-on consultative workflow transformation and training/education services to PCPs and facilities enrolled in the organization's value based reimbursement programs and clinical evidence based guidelines. Assess data for the highest ROI opportunities in PCP performance, and implement strategic plans to meet identified program targets across all of the organization's value based programs for both the commercial and government business (ACA, Medicare STARS, Medicaid HEDIS, risk revenue). Function as the organization's representative SME in value based reimbursement programs, pharmacy, and data analysis. Analyze and interpret PCP and facility value based reimbursement reports in the areas of National Quality Standards like NCQA, HEDIS, NQF, PQRS etc., and cost and utilization and develop strategic plans to meet PCP program targets to create value, impact and cost savings, as well as meeting the ROI as identified by the organization. Independently and autonomously manage PCP and facility caseloads, projects, meetings, deliverables, resources etc. for individualized strategic plans to transform PCP and facility practices enrolled in value based reimbursement program(s) using innovative continuous improvement methodologies. Serve as the clinical SME for PCP value based reimbursement programs, Medicare STARS, Medicaid HEDIS, for both the organization's internal and external key stakeholders. Function in a matrixed role supporting the development and strategic integration of clinical care models for chronic conditions and in collaboration with departments across the enterprise. Other duties as assigned. Education: Required: Bachelor's Degree in Pharmacy Substitutions: None Preferred: Master's Degree in Health Administration or Business or Doctorate Degree in Pharmacy (PharmD) Experience: Required: 5 - 7 years in Pharmacy or 3 - 5 years in a Clinical Practice or Completion of PGY-1 Residency or Completion of a Pharmacy Fellowship Preferred (any one of the following): 5 - 7 years in Medicare or 5 - 7 years in Managed Care Support or 3 - 5 years in Quality Improvement or 3 - 5 years in Care Management or 3 - 5 years in Utilization Review or 3 - 5 years in the Health Insurance Indus Licenses and Certifications: Required: Registered Pharmacist License Preferred: Board Certified Pharmacotherapy Specialist or Board Certified Ambulatory Care Pharmacist or Board Certified Geriatric Pharmacist Skills: Analytical Skills Medicare Presentation Delivery Managed Care Healthcare Care Planning Continuous Improvement Utilization Management Healthcare Management Utilization Review Language (Other than English): None Travel Required: 50% - 75% Physical, Mental Demands and Working Conditions: Position Type: Office-Based Teaches / trains others regularly Constantly Travel regularly from the office to various work sites or from site-to-site Frequently Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Lifting: up to 10 pounds Occasionally Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Occasionally 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. Pay Range Minimum: $78,900.00 Pay Range Maximum: $147,500.00 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.

Created: 2026-03-04