Graduate Pharmacist, Resident (Health Plan)

UPMC Health Plan has an exciting opportunity for a Graduate Pharmacist Resident in the Pharmacy Services department. This is a full-time position working Monday through Friday daylight hours. This will be a remote position with a hybrid option. The Graduate Pharmacist provides services for the clinical pharmacy team. The graduate pharmacist is responsible for developing and implementing clinical projects, and assisting in other daily activities that are completed in the pharmacy department. The tasks performed by the graduate pharmacist are similar to a clinical pharmacy specialist. The clinical projects and daily activities will be performed in compliance with state and federal regulations, NCQA standards, the mission, policies and procedures of the Health Plan. This position will start on July 6th, 2026, and end on June 30th, 2027. Responsibilities:

• Operational Activities: Critically review of medication based prior authorization requests for approval/denial against standard criteria. Review and participate in member appeal cases, including hearings. Support the pharmacy call center by answering the phone queue to assist call representatives.
• Clinical Activities: Research adequately and be properly prepared for all P&T Committee meetings, ensuring all recommendations for both new drugs and new policies are appropriate and have been discussed with subject matter experts. Present these assignments succinctly and at a suitable pace, volume, and speed and answer all questions. Develop and conduct Drug Utilization Review (DUR) activities, Medication Therapy Management (MTM), and other integrated programs with medical management. Create, develop, maintain and enhance clinical reporting programs, including but not limited to physician specific reporting, alternative prescribing programs for utilization, assigned client plans, etc. Work with the University of Pittsburgh to complete journal clubs, seminars, and research project. Pipeline monitoring and evaluation. Provide innovative and applicable ideas in clinical program development, utilization management, formulary management, provider education, therapeutic substitution, MTM/DUR, and/or improvements in programs and edits that already exist, including both improving operational efficiencies, as well as developing new clinical edits. Implement these new ideas or improvements as approved, while also considering outcomes in all programs. Work with employer clients, account management, and sales in client and member meetings as assigned to improve the understanding of the pharmacy benefit, as well as offering recommendations.
• Administrative: Participate in meetings, committees, and work groups both internally and externally as assigned. Maintain a solid understanding of the requirements of the Pennsylvania Department of Health, DPW, CMS and the National Committee for Quality Assurance, specifically as they relate to the expectations of pharmacy operations. Ensure compliance with regulatory and accreditation requirements of clinical functions.
• Communication: Foster and maintain collaborative relationships with internal and external customers. Communicate pharmacy information as appropriate to members, employer groups, and providers. Develop communication materials to providers, including discussions regarding formulary changes/adherence, health education, medication compliance, and trend management.
• Teaching and Education: Mentor and precept pharmacy students.
• Special Skills/Ability to Interact: Have ability to function independently, but support team concept. Behavior denotes reliability as demonstrated by prompt attendance and timeliness completing designated workload and follow-up. Conveys and maintains professional image while interacting with coworkers, providers and clients. Honor client and patient confidentiality. Performs in accordance with system-wide competencies/behaviors. Performs other duties as assigned.
• Performs in accordance with system-wide competencies/behaviors.
• Performs other duties as assigned.

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