Health Outcomes Pharmacist – DSNP

• Provide evidence-based clinical recommendations to optimize medication use for members with complex or chronic conditions
• Conduct medication reviews, identify drug therapy problems, and collaborate with providers and care managers on interventions
• Partner with care management, disease management, and interdisciplinary teams to support medication optimization and health outcomes
• Contribute to care plans for high-risk or high-cost populations
• Serve as a subject matter expert on formulary, prior authorization, and step therapy protocols
• Respond to pharmacy inquiries from providers, members, and internal departments
• Support HEDIS, CMS Star Ratings, and medication-related quality initiatives
• Identify and address gaps in care through outreach and interventions
• Educate providers on formulary changes and prescribing best practices
• Conduct member outreach supporting medication understanding, adherence, and wellness
• Ensure compliance with state and federal pharmacy regulations, including Medicare Part D and Medicaid guidelines
• Assist with reporting and documentation for audits, accreditation, and internal reviews
• Analyze pharmacy and medical claims data to identify trends, risks, and improvement opportunities
• Track and report clinical outcomes, program impact, and performance benchmarks
• Participate in pharmacy quality improvement programs and pilot projects
• Contribute to continuous improvement of pharmacy and care coordination services
• Participate in boards, committees, task forces, and organizational meetings
• Perform other related duties as assigned

Requirements

• Current pharmacist license through the applicable state board (Pennsylvania, Maryland, Ohio, or West Virginia)
• Remote workers must additionally hold a current pharmacist license issued by their state of residence
• Three years of experience in a managed care, health plan, or population health environment
• Three years of experience with quality measurement programs including HEDIS, Star Ratings, Medicare Advantage, and Medicaid regulations
• Three years of clinical pharmacy practice
• Ability to handle confidential information
• Articulate oral and written communication and presentation skills
• Ability to work in a fast-paced, rapidly changing environment with attention to detail
• Ability to research and resolve complex issues independently
• Experience with regulatory and accreditation standards
• Ability to apply relevant laws, regulations, requirements, and policy standards
• Working knowledge of Microsoft Office applications including Excel, Outlook, PowerPoint, Teams, electronic medical records, and MTM platforms
• Ability to stand and walk short distances for eight or more hours
• Frequent bending, stooping, or stretching
• Ability to lift 30 pounds and push 50 pounds
• Preferred: Managed Care Residency, Ambulatory Care Residency, or board certification such as BCPS, BCACP, or BCGP
• Preferred: In-depth knowledge of Medicare Part D and Medicaid pharmacy benefits
• Preferred: Experience collaborating with interdisciplinary care teams, case managers, and providers
• Preferred: Experience with Medication Therapy Management and MTM platforms
• Preferred: Proficiency with EHR systems such as EPIC

Core Competencies

Demonstrates expertise in clinical pharmacy practice, medication optimization, and quality measurement programs, with a strong focus on HEDIS and CMS Star Ratings. Proficient in collaborating with interdisciplinary teams and ensuring compliance with pharmacy regulations.

Highest-signal resume keywords

• Current Pharmacist License
• Clinical Pharmacy Practice
• Quality Measurement Programs
• Medication Therapy Management
• Regulatory Compliance

ATS Optimization Keywords

Hard Skills

• Medication Reviews
• Drug Therapy Problem Identification
• Clinical Outcome Tracking
• Pharmacy Claims Data Analysis
• Care Plan Contribution

Soft Skills

• Articulate Communication
• Attention to Detail
• Independent Problem Solving

Certifications & Qualifications

• Managed Care Residency
• Ambulatory Care Residency
• BCPS
• BCACP
• BCGP

Industry Keywords

• HEDIS
• CMS Star Ratings
• Medicare Part D
• Medicaid Guidelines
• Pharmacy Quality Improvement

Tools & Technologies

• Microsoft Office
• Electronic Medical Records
• MTM Platforms
• EHR Systems