Clinical Pharmacist, Specialty Drug Cost Containment

LTHC

. Support the health plan’s comprehensive medication management program by identifying high-impact members using high-cost specialty medications .

Posted 10/5/2026full-timeRochester • New York • United StatesJuniorMid-Level💰 $98,297 - $176,935 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in comprehensive medication management, including evaluating cost-effective treatment regimens and optimizing specialty medication use. Proficient in clinical recommendations, medication reviews, and managing complex member caseloads while collaborating with healthcare providers and internal teams.

Highest-signal resume keywords

Current New York State Pharmacist LicensePharm.D. or Bachelor of Science in PharmacyManaged Care ExperienceStrong Clinical KnowledgeProficient in Microsoft Office Suite

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Comprehensive Medication ManagementCost-Effective Treatment EvaluationClinical RecommendationsMedication ReviewDrug Regimen ReviewSpecialty Medication OptimizationPharmacy Case ManagementData AnalysisAdverse Event EvaluationTherapeutic Duplication Assessment

Soft Skills

Excellent Interpersonal SkillsConsultative SkillsProblem-Solving SkillsVerbal Communication SkillsWritten Communication Skills

Tools & Technologies

Claims Data AnalysisTechnology-Enabled WorkflowsAutomated Reporting SystemsPredictive Insights ToolsMember Outreach Platforms

Certifications & Qualifications

Pharmacist License

Industry Keywords

Managed Care Pharmacy ProgramsSpecialty PracticePatient Management InitiativesCost-Effective ProgramsHealthcare Setting Experience

About the role

Key responsibilities & impact

Support the health plan’s comprehensive medication management program by identifying high-impact members using high-cost specialty medications
Execute pharmacy-driven cost reduction strategies, including stop-loss initiatives
Evaluate cost-effective treatment regimens and optimize specialty medication use
Improve member outcomes and reduce total cost of care in collaboration with providers, members, pharmacies, and internal teams
Generate clinical recommendations and conduct comprehensive medication reviews using prescription and medical claim data
Recommend clinically appropriate therapy alternatives, dose optimization, deprescribing opportunities, alternative treatment pathways, contracting considerations, and program enrollments
Perform clinical and financial reviews of high-cost and stop-loss eligible pharmacy claims
Support specialty medication adherence and appropriate utilization initiatives
Execute manual and technology-enabled workflows through platform development
Evaluate medication-related problems, including adverse events, therapeutic duplication, adherence, polypharmacy, and untreated conditions
Analyze, document, and report member outreach and intervention performance results
Use formulary information and member-specific benefits to guide medication recommendations
Level II: create and implement strategies for highly complex members and pharmacy outreach programs
Level II: monitor the drug pipeline and educate members and case management teams on future trends and opportunities
Level II: develop strategies and reporting for pharmacy case management and referrals
Level II: maintain complex-member caseloads and track outreach impact, outcomes, spending, and satisfaction
Level II: collaborate with clinical strategy, medical management teams, and external resources on commercial and government programs
Level II: develop automated reporting and organize caseloads, value stories, and process improvements
Level II: prioritize outreach using predictive insights, savings potential, member risk, and ROI
Level II: drive program scalability by evaluating line-of-business differentiators
Level II: mentor new staff as needed
Adhere to the Corporate Code of Conduct, Lifetime Way values, privacy policies, and procedures
Maintain regular and reliable attendance
Perform other functions as assigned by management

Requirements

What you’ll need

Current New York State Pharmacist license
Pharm.D. or Bachelor of Science in Pharmacy, plus at least two years of experience in an organized healthcare setting, or completion of a PGY-1 residency
Managed care experience strongly preferred, especially direct physician interaction, clinical practice, or direct patient interaction
Excellent interpersonal, consultative, and problem-solving skills
Excellent verbal and written communication skills with experience communicating with members and other health care professionals
Ability to manage multiple patient care plans and/or claims files in a fast-paced environment while maintaining attention to detail and accuracy
Knowledge and skill to conduct a thorough drug regimen review
Strong clinical knowledge kept current through continuing education and professional affiliations
Strong computer skills
Proficient knowledge of Microsoft Word, Excel, Outlook, and PowerPoint
Ability to learn new systems
Level II: minimum of three years of experience in an organized health care setting with strong clinical pharmacy knowledge, including participation in patient management initiatives
Level II: extensive knowledge of innovative managed care pharmacy programs and proven clinical track record of developing cost-effective, high-quality programs
Level II: extensive command of specialty practice, including diseases, published literature, and medication therapies for specific patient populations
Level II: innovative thinking and effective communication on clinical decision making and pharmacy case management strategies
Level II: ability to track and identify drug trends through claims data and member experiences
Level II: experience working with highly complex members with physical and behavioral health needs
Ability to work while sitting and/or standing at a workstation using a computer, keyboard, mouse, and/or phone for three or more hours at a time
Ability to work in a home office for continuous periods for business continuity
Ability to travel across the Health Plan service region for meetings and/or trainings as needed
Manual dexterity, repetitive motion, and ability to hear, understand, and speak clearly while using a phone

Benefits

Comp & perks

Group health and/or dental insurance
Retirement plan
Wellness program
Paid time away from work
Paid holidays
Possible remote work on a case-by-case basis
Equal opportunity employment