Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Senior Clinical Pharmacy Specialist

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Manager & Professional
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190A0 Requisition #
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Provide management and specialty clinical pharmacy services, including appropriate drug therapy recommendations and prior approvals to EmblemHealth participating providers. Work with practitioners to make clinical decisions, which will enhance the quality of patient care and contain health care costs.

Responsibilities:
  • Review requests for authorization for Medicare, NYS Medicaid, Commercial, and Exchange lines of business.
  • Conduct CMS MTM medication reviews. Coordinate interventions with physicians upon medication review.  Provide medication review letters to members.  Ensure CMS compliance with the MTM program.
  • Participate in the Pharmacy & Therapeutic Committee to include: Step-Protocol Review, Non-Formulary Review, Subcommittee Management (Meetings/minutes), Drug Reviews, and Updates.
  • Development and maintenance of drug policies.
  • Other duties/projects as assigned.
Qualifications:
  • Doctor of Pharmacy degree or Masters in Pharmacy from an accredited school of pharmacy with clinical and drug information experience
  • Registered Pharmacist: New York State pharmacy license or eligible to obtain New York State license
  • A minimum of 5 years of experience required
  • Residency or 5 years’ clinical experience preferred preferred
  • Knowledge of pharmaceuticals and disease states to provide advice and consultation to providers and members, and recommend changes to the formulary required
  • Possess research and analytical skills sufficient to provide problem resolution and consultation to providers required
  • Excellent verbal and written communication skills sufficient to prepare own correspondence and interact with members and providers in provision of advice and guidelines required

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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