Clinical Outcomes Pharmacist

Company: Highmark Inc. Job Summary: Join us as a Clinical Outcomes Pharmacist, a pivotal role that drives value creation and helps achieve the organization's financial objectives. You will work closely with primary care providers (PCPs) and facilities in our value-based reimbursement programs. This position calls for your expertise in clinical pharmacy, medication therapy management, and a deep understanding of healthcare metrics to enhance patient care while optimizing costs. Essential Responsibilities: Serve as a clinical pharmacy expert, providing crucial guidance on enhancing medication adherence and improving quality metrics. Conduct on-site and virtual training sessions for PCPs and facilities participating in our programs, ensuring support is tailored to their unique needs and promoting engagement. Analyze key data to identify high ROI opportunities for PCP performance, implementing strategic initiatives to meet program targets in various business areas. Represent our organization in discussions regarding value-based reimbursement, effectively presenting program results and insights to stakeholders. Evaluate national quality standards and reports, crafting strategic plans to improve performance in cost and utilization metrics, ensuring compliance with ROI targets. Independently manage caseloads and projects, focusing on innovative methods to transform practices for PCPs in value-based programs. Act as a clinical resource for stakeholders regarding Medicare STARS and Medicaid HEDIS programs, collaborating with departments to provide comprehensive support. Engage in the development and integration of clinical care models for chronic conditions alongside enterprise departments. Perform additional 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 Clinical Practice or Completion of PGY-1 Residency or Completion of a Pharmacy Fellowship Preferred: 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 Knowledge Presentation Skills Managed Care Expertise Healthcare Knowledge Care Planning Abilities Continuous Improvement Mindset Utilization Management Skills Healthcare Management Understanding Utilization Review Skills Language Requirements: None Travel Required: 50% - 75% Physical, Mental Demands and Working Conditions: Position Type: Office-Based Teaches and trains others regularly Constantly Travels regularly from the office to various work sites or from site-to-site Frequently Physical work site requirement: Yes Lifting: up to 10 pounds: Occasionally Lifting: 10 to 25 pounds: Occasionally Lifting: 25 to 50 pounds: Occasionally Disclaimer: This job description provides an overview of the typical tasks, responsibilities, and qualifications for this role but may not encompass all duties and expectations. Compliance with ethical and legal standards, including HIPAA and company policies, is mandatory. We uphold the highest standards of diversity and inclusion in our hiring processes. Pay Range Minimum: $78,900.00 Pay Range Maximum: $147,500.00 Base pay varies based on qualifications, experience, and contributions, as well as market and business considerations. Request ID: J274585

Created: 2026-03-04