Quality Performance Clinical Pharmacist, Managed Care
Overview
Own pharmacy quality performance for 28 million members across Medicare, Medicaid, and Marketplace lines of business. Partner with health plans and provider groups to accelerate pharmacy measure outcomes. Lead cross-functional initiatives that close quality gaps and improve member care. This role offers a remote schedule with 50% travel to provider offices in the Brooklyn, Jamaica, or Queens areas.
What You'll Do8
- 1Drive pharmacy quality performance across Medicare, Medicaid, and Marketplace lines of business.
- 2Partner with health plans and provider groups to implement pharmacy quality initiatives.
- 3Provide clinical and quality expertise to internal teams and external provider partners.
- 4Develop and present performance reviews with provider-facing teams to address pharmacy chapter quality.
- 5Strategize and coordinate between market and enterprise pharmacy measure initiatives.
- 6Identify operational opportunities to accelerate pharmacy measure performance.
- 7Facilitate training on enterprise pharmacy quality initiatives for provider-facing teams.
- 8Support enterprise pharmacy quality initiatives as a subject matter expert.
Requirements7
- 1Bachelor's degree or advanced degree (PharmD or M.S.) in pharmacy required.
- 23+ years of retail or hospital pharmacy experience, or 1+ years of managed care pharmacy experience required.
- 3Clinical pharmacy experience in a managed healthcare environment preferred.
- 43+ years managed care pharmacy or pharmacy benefit management experience preferred.
- 5PHARM-R - Registered Pharmacist with a current state license with no restrictions.
- 6Candidates must reside in the Brooklyn, Jamaica, or Queens areas.
- 7Ability to travel 50% or more to provider offices and community pharmacies within the assigned region.
Salary Insight
$108 - $199k per year
Location
Required Skills
Similar open positions
Explore active roles that match your skills and interests.
Care Well RX Inc
VerifiedSupervising Pharmacist, Retail & Clinical Care
You will own pharmacy operations at Care Well RX Inc, a high-volume retail location in New York, serving 500+ patients daily. You direct a team of 3-5 technicians, manage inventory, and ensure clinical compliance. You also build patient counseling programs that cut readmission rates by 15%. This role pairs hands-on dispensing with strategic oversight, a rare mix in retail pharmacy.
UnitedHealthcare
VerifiedClinical Pharmacist, Telephonic Patient Care - Texas
You will own telephonic outreach to UHC Medicare members, improving medication adherence and drug utilization at scale. You will work with a collaborative pharmacy team focused on clinical and business outcomes. This remote role requires monthly office visits in Houston, TX, and daily presence during the 3-week training period. You will directly impact CAHPS scores and Star Ratings, with medication adherence contributing 14% to the rating.
Thriftcare Pharmacy
VerifiedSupervising Pharmacist, Clinical Pharmacy & LTC
Lead pharmacy operations at Thriftcare Pharmacy in New York, overseeing medication dispensing, patient counseling, and team coordination. Manage daily workflows, ensure DEA and HIPAA compliance, and drive patient care in a community setting. Work alongside physicians and nurses to resolve medication issues. This role offers the chance to apply clinical expertise in a hands-on environment.
Briljent
VerifiedClinical Project Manager, Pharmacy Benefit Management
Own delivery of pharmacy clinical initiatives in a Medicaid PBM environment. You will lead projects from drug coverage administration to PDL management and prior authorization programs, coordinating cross-functional teams. Work fully remote with stakeholders including pharmacy directors, clinical pharmacists, technology teams, and external vendors. This contract role runs 10 months with immediate start, no travel, and a background check required. You will shape solutions that meet strict regulatory requirements and improve member outcomes.
Insight Global
VerifiedPharmacist, Prior Authorization and Appeals - Remote
You will own the clinical review of prior authorization and appeals requests for a high-volume, fully remote pharmacy team. You will apply evidence-based guidelines to make coverage decisions across Medicare Part D, Medicaid, and commercial plans. Working with physicians, pharmacy technicians, and internal teams, you will resolve inquiries, support quality initiatives, and improve processes. This role offers direct impact on patient access to medications in a collaborative environment.
Neighborhood Drugs of Hallandale
VerifiedPharmacist in Charge, Independent Pharmacy & Clinical Care
You will own daily pharmacy operations at an independent pharmacy under new management, directing staff and verifying prescriptions to ensure safe dispensing. You will drive clinical services including MTM, immunizations, and patient counseling while maintaining HIPAA compliance and inventory control. Working onsite in Miami, you will collaborate with healthcare professionals to improve patient outcomes. This role offers competitive pay and unmatched growth potential for a pharmacist passionate about reforming healthcare.