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Job Details

Clinical Pharmacy Manager

Job Ref: 67493
Category: Professional
Department: PHARMACY ADMIN
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $135,000.00
Salary Range: $135,000.00 - $135,000.00

About NYC Health + Hospitals

MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. 

Position Overview


The Clinical Pharmacy Manager is responsible for identifying criteria and medications to continuously improve drug utilization management strategies for the pharmacy and medical benefit across all lines of business. The Clinical Pharmacy Manager is also responsible for administering and managing all clinical programs, including but not
limited to individual case management, population management and medication therapy management. Salary commensurate with experience and education. 

Job Description

Completes annual review for all prior authorization criteria to ensure the most up to date clinical
guidelines and therapies are incorporated for optimal, medically appropriate utilization management
• Creates prior authorization criteria for new medications as needed
• Performs quarterly and ad-hoc assessment of formularies, using internal and external trends to ensue
formulary appropriateness
• Administers and manages all pharmacy case management programs, including the Behavioral Health
Pharmacy Program
• Provides education to staff on new therapies, new criteria, new guidelines to ensure internal pharmacy
staff are well versed on up to date trends
• Assist in responding to internal/external inquiries related to prior authorization reviews
• Assists in identifying inappropriate utilization during quality check reviews for claims and prior
authorizations by internal or PBM delegated reviews
• Assists in identifying potential Fraud, Waste and Abuse scenarios
• Completes medication reviews for Plan members to ensure safe and effective therapy
• Assists in organizational and departmental quality improvement initiatives
• Manages internal Pharmacy and Therapeutics (P&T) meetings

Minimum Qualifications

• Doctor of Pharmacy required
• Clinical pharmacy experience and utilization management experience in a managed care environment
required
• Experience in pharmacy management of government programs (Medicaid, Medicare, Exchange)
preferred
• Residency PGY-1 training preferred.
• Proficiency with MS Word, Excel, and PowerPoint is required
• Proficiency with MS Access is preferred
• Position requires excellent organizational, teamwork, interpersonal, time management, written and
verbal communication skills

Current New York State Pharmacist license (active and not limited)