Job Description
Job Title: Pharmacist – Claims Data Analysis & Medication Management
Job Location: Remote Position (Prefer the Pharmacist to be in FL, CO, TX) Job Type: Full-Time
About Meta Care Inc.: At Meta Care Inc., we are driven by passionate entrepreneurs committed to enhancing patient health and well-being nationwide. We offer personalized care and support to our clients and deeply value the contributions of every team member.
Job Summary: We are seeking an analytical and detail-oriented Pharmacist to join our team in a non-patient-facing role focused on reviewing claims data to identify opportunities for optimizing pharmaceutical spending. This position will involve analyzing medication utilization trends, recommending cost-effective alternatives (such as brand-to-generic substitutions), identifying unnecessary medications for discontinuation, and providing patient education, with recommendations, about their medication changes when transition from hospital to home. The pharmacist will work closely with the care management team to develop strategies that decrease pharmaceutical costs for our clients, implement proposed plans, forecast impacts, and provide regular performance summaries.
Key Responsibilities: - Claims Data Review & Analysis:
- Perform comprehensive formulary reviews to include recommendations on costs-containment strategies that don’t compromise quality of care.
- Analyze medication claims data to identify cost-saving opportunities and trends in pharmaceutical utilization.
- Evaluate medication regimens to identify opportunities for site-of-care changes for infusion therapies that reduce costs without compromising patient care.
- Recommend brand-to-generic medication switches when appropriate to reduce pharmaceutical spend.
- Review and identify medications that are no longer necessary or have exceeded their therapeutic timeline and suggest discontinuation to lower overall costs.
- Medication Reconciliation (Post-Discharge):
- These reconciliations are non-clinical with a focus on patient education and safety.
- Review claims data for patients returning home after discharge to ensure that their medication regimens are aligned with the most cost-effective and clinically appropriate options.
- Ensure there are no medication duplications or contraindications and provide recommendations for optimization of therapy that align with the goal of cost reduction.
- Collaboration with Care Management Team:
- Work closely with the care management team to identify and address medication-related issues that could affect patient outcomes and pharmaceutical spending.
- Collaborate on strategies for improving medication adherence, reducing unnecessary medications, and optimizing therapy, particularly for high-risk patients.
- Provide the care management team with medication-related recommendations to support overall patient care and cost-saving initiatives.
- Opportunity Implementation & Forecasting:
- Develop and implement strategies based on identified opportunities, with a focus on decreasing overall pharmaceutical spend for the client.
- Forecast the potential impact of implemented changes on both patient care and pharmaceutical expenditures, providing a clear plan for implementation.
- Reporting & Performance Evaluation:
- Summarize findings and opportunities in clear, concise reports for internal teams and clients.
- Track and report the financial outcomes of implemented changes, with a focus on demonstrating reductions in overall pharmaceutical spend.
- Provide quarterly reports and presentations that summarize the impact of your work, highlighting cost savings and improvements.
- Collaboration:
- Collaborate with internal teams, such as analytics and account management, to ensure alignment on cost-saving strategies and client objectives.
- Communicate with cross-functional teams to ensure effective execution of cost-reduction plans.
Qualifications: - Doctor of Pharmacy (PharmD) degree from an accredited institution.
- Minimum of 5 years of experience in clinical pharmacy practice, pharmacy data analysis, or a related field.
- Strong background in reviewing claims data, identifying trends, and making medication-related recommendations with an emphasis on cost reduction.
- Experience in formulary management, medication therapy management, and cost-control strategies.
- Familiarity with healthcare data analysis tools and electronic health records (EHR).
- Strong analytical skills and ability to work with complex datasets to identify cost-saving opportunities.
- Excellent communication skills for writing clear reports and summaries for internal teams and clients.
- Strong organizational skills with the ability to manage multiple projects and track performance metrics.
Preferred Qualifications: - Experience in a managed care or pharmacy benefits management (PBM) environment.
- Experience in cost-effectiveness analysis or working with pharmaceutical spend reduction initiatives.
Performance Metrics: This role will be measured based on the effectiveness of cost-saving recommendations and strategies, specifically reductions in overall pharmaceutical spend for the client. The pharmacist will be expected to demonstrate measurable outcomes through financial analysis, with an emphasis on optimizing pharmaceutical utilization.
To Qualify please indicate your residentce, because the Job Location: Remote Position (Prefer the Pharmacist to be in FL, CO, TX) Compensation and Benefits: - Salary is $70K to $80K based on experience
- Comprehensive benefits package includes medical, dental, and vision insurance, retirement plans, and paid time off.
- Company will contribute 90% of individual medical health benefits
Equal Employment Opportunity: Meta Care Inc. is dedicated to fostering a diverse and inclusive environment and is proud to be an equal-opportunity employer. We provide equal consideration to all qualified applicants, regardless of race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Send Resume to Cristina Spiegel, cspiegel@metacareusa.com Contact number: 631-245-0532
Job Tags
Holiday work, Full time,