Clinical Health Outcomes Pharmacist

Company: Highmark Inc. Job Description: JOB SUMMARY This role plays a vital part in driving value creation and achieving fiscal targets for the Organization. The Health Outcomes Pharmacist will engage with primary care providers (PCPs) and facilities participating in the Organization's value-based reimbursement programs. This position requires expertise in clinical pharmacy, medication therapy management, and various healthcare metrics to enhance patient care and optimize costs. ESSENTIAL RESPONSIBILITIES Act as a Clinical Pharmacy expert, providing guidance on pharmacy-related interpretations and strategies to enhance medication adherence and quality metrics. Offer on-site and virtual training to PCPs and facilities enrolled in value-based reimbursement programs, tailoring support to meet their specific needs and drive engagement. Analyze data to identify high ROI opportunities for PCP performance, implementing strategic plans to meet program targets across multiple business areas. Represent the Organization in value-based reimbursement discussions, presenting program results and insights to various stakeholders. Evaluate national quality standards and reports, developing strategic plans to enhance performance in cost and utilization metrics while ensuring compliance with set ROI targets. Manage caseloads and projects independently, focusing on innovative methodologies to transform practices for PCPs enrolled in value-based reimbursement programs. Serve as a clinical resource for key stakeholders regarding Medicare STARS and Medicaid HEDIS programs, collaborating with various departments for comprehensive support. Participate in the development and strategic integration of clinical care models across chronic conditions in collaboration with enterprise departments. Perform other duties as assigned. EDUCATION Required Bachelor's Degree in Pharmacy Substitutions None Preferred Master's Degree in Health Administration or Business Doctorate Degree in Pharmacy (PharmD) EXPERIENCE Required 5 - 7 years in Pharmacy 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 5 - 7 years in Managed Care Support 3 - 5 years in Quality Improvement 3 - 5 years in Care Management 3 - 5 years in Utilization Review 3 - 5 years in the Health Insurance Industry LICENSES AND CERTIFICATIONS Required Registered Pharmacist License Preferred Board Certified Pharmacotherapy Specialist Board Certified Ambulatory Care Pharmacist 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 Never Physical work site required Yes Lifting: up to 10 pounds Occasionally Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Occasionally Disclaimer: This 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 set forth in the code of business conduct and company policies. Employees may access confidential information that must be protected at all times. Therefore, all employees must comply with the Health Insurance Portability and Accountability Act (HIPAA) and the company's privacy policies and security guidelines. It is essential for employees to adhere to the company's Code of Business Conduct, which includes compliance with all applicable laws and regulations. Pay Range Minimum: $78,900.00 Pay Range Maximum: $147,500.00 Base pay is determined by factors including qualifications, experience, and expected contributions, as well as internal equity, market, and business considerations. Highmark Health and its affiliates are committed to diversity and prohibit discrimination against qualified individuals based on any protected status. We strive to ensure website accessibility and welcome inquiries regarding assistance with the application process. Request ID: J274585

Created: 2026-03-04