Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
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Pharmacist, Clinical Programs - Hybrid
- 💼
- EmblemHealth
- 📅
- Jul 01, 2026 Post Date
Summary of Job
Act as collaborator or point for the integration and oversight of pharmacy programs with enterprise-level initiatives in quality, care and utilization management, using digital tools. Design and manage strategic projects, including supporting business case development, PMO, and coordination across teams. Collaborate with VP, Pharmacy, pharmacy and lines of business product owners to maintain alignment across medical and pharmacy products, including PDP. Coordinate with operations team as needed for client benefit intent management. Lead and support Clinical, Care Management and Quality teams across multiple lines of business as assigned. Key contact for delegation oversight of vendors and related programs for the pharmacy department. Contribute to the overall success of Pharmacy Programs by promoting /advancing the department mission of effectively managing members and improving program outcomes. Coordinate with EH Enterprise quality team to oversee and drive clinical programs outcomes and ROI monitoring (e.g., non-NYC MTM, targeted programs for GLP-1, Obesity, diabetes, etc.)
Responsibilities
- Serve as a clinical subject matter expert (SME) for medication-related care management strategies, integrating pharmacy insights into holistic member care plans across lines of business.
- Drive integration of pharmacy data into care management workflows, leveraging analytics to identify gaps in care, adherence risks, and intervention opportunities.
- Identify and stratify high-risk members using pharmacy and medical data to prioritize care management interventions. Support utilization, monitoring, and cost management of high cost/specialty members/drugs.
- Support training and upskilling of care management staff on pharmacy-related topics, including drug trends, adherence barriers, and therapeutic updates.
- Participate in care management and interdisciplinary team meetings to share insights and recommendations.
- Educate pharmacy and internal EmblemHealth staff to understand pharmacy concepts and programs that effectively contribute to managing members with chronic health conditions.
- Educate business partners on the development of new pharmacy offerings including design, development of project plans, leading meetings, and implementation of innovative programs and processes.
- Actively participate in vendor presentations and meetings to help identify, develop, and maintain project progress.
- Interface and work collaboratively with key departments and other healthcare vendors.
- Develop methodologies for pharmacy program assessment inclusive of ROI and proof points of program outcomes.
- Monitor and improve program effectiveness to meet program and departmental goals.
- Actively participate in delegation oversight with multiple Pharmacy services vendors to ensure company and regulatory compliance. Review and triage single case agreements needs to the Operations team for execution.
- Oversee Comprehensive Medication Reviews (CMRs) and Medication Reconciliations as part of Commercial and Medicare pharmacy support for members.
- Coordinate with vendors to oversee metrics, performance, and ensure appropriate member experience.
- Oversee regulatory material review and develop improvements for leadership review.
- Support NCQA and other regulatory requirements that are applicable to pharmacy programs.
- Effectively partner with leadership to continually advance our programs.
- Support marketing activity and other corporate objectives.
- Perform related tasks, duties, and special projects as directed, assigned, or required.
Qualifications
- Bachelor’s Degree, Masters, or Doctor of Pharmacy
- Registered Pharmacist with active Pharmacist license (Required)
- Project / Program management certification or related - Six Sigma, Lean, PMI certification (Preferred)
- 8 – 10+ years of relevant, professional work experience (Required)
- Knowledge of Pharmacy and ability to interpret data (Required)
- Experience working in a matrix management environment; ability to collaborate effectively with internal/external parties (Required)
- Ability to effectively organize, prioritize, and manage multiple programs (Required)
- Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience (Required)
- Ability to utilize information to develop actionable reports and presentations (Required)
- System user experience in a highly automated environment (Required)
- Proficient with MS Office - Word, Excel, PowerPoint, Access, Outlook, Teams, etc. (Required)
- State of the art knowledge of disease management processes (Required)
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, age, creed, citizenship status, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.