Pharmacist at Upper Peninsula Health Plan

Marquette, Michigan, United States -

Full Time

Start Date

Immediate

Expiry Date

27 Apr, 26

Salary

52.19

Posted On

27 Jan, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Pharmacy Degree, Michigan Licensure, Clinical Quality Improvement, Data Analysis, Communication Skills, Organizational Skills, Problem-Solving, Attention to Detail, Self-Management, Keyboarding Proficiency, MS Office Knowledge, Public Speaking, Drug Utilization Review, Research Skills, Educational Development, Fraud Monitoring

Industry

Insurance

Description

DATE: January 26, 2026 POSITION: Pharmacist DEPARTMENT: Pharmacy BASE RATE: $52.19 per hour, with potential for additional compensation based on qualifications POSITION SUMMARY: Responsible for assigned pharmacy functions in accordance with Upper Peninsula Health Plan (UPHP) plans and policies and all state and federal accrediting and regulatory standards; supports the pharmacy director in development, organization, implementation, and communication of pharmacy initiatives and projects to maintain and improve quality and cost effectiveness of administrative, operational, clinical, and drug utilization management programs. ESSENTIAL DUTIES AND RESPONSIBILITIES: 1. Follows established Upper Peninsula Health Plan (UPHP) policies and procedures, objectives, safety standards, and sensitivity to confidential information. 2. Demonstrates knowledge of all relevant Michigan Department of Health and Human Services (MDHHS), Centers for Medicare and Medicaid Services (CMS), and Department of Insurance and Financial Services (DIFS) standards; all applicable National Committee for Quality Assurance (NCQA) Utilization Management (UM), Quality Improvement (QI), and Member's Rights and Responsibility (RR) standards; and Healthcare Effectiveness Data and Information Set (HEDIS®) measures as they relate to pharmacy functions and respective programs; assumes responsibility for specific NCQA standards as assigned. 3. Identifies and contributes to the development and implementation of pharmacy programs to improve the cost- effective, evidence-based management of the prescription drug benefit and drug utilization program standards. 4. Performs clinical quality improvement activities and studies related to drug utilization and prepares reports and analyzes data as assigned. 5. Communicates with other health care professionals, internally and externally, including customer service, care managers, physicians, physician office staff, pharmacies, and pharmacy benefit manager (PBM) personnel in an effective and timely manner. 6. Responsible for the day-to-day processing of prior authorizations, appeals, override requests, grievances, member, and provider education calls in compliance with regulatory and clinical practice standards including timely and accurate record keeping and reporting. 7. Performs research, development, implementation, and maintenance of drug utilization management criteria, necessary to support clinical practice guidelines, formulary requirements, and drug utilization management activities. 8. Develops, prepares, and coordinates distribution of the drug formulary, newsletters and drug utilization management, and other materials for providers and members concerning formulary and pharmacy topics. 9. Assists in the development, maintenance, and execution of policies and procedures related to pharmacy management and performs duties in accordance with regulatory requirements and accrediting standards. 10. Performs duties as related to maintaining and preparing NCQA Standards, CMS audits, and other regulatory and contractual reporting as appropriate. 11. Responsible for conducting all responsibilities in alignment with CMS and MDHHS reporting and auditing requirements. 12. Performs monitoring, auditing, and follow up of fraud waste and abuse of medications and services. 13. Reviews member medication profiles and claims data and applies evidence-based medicine and national guidelines when crafting recommendations for health care providers. 14. Performs drug utilization review (DUR) activities by evaluating medication lists and claims history for potential drug interactions, suboptimal medication regimens, drug safety, and adherence concerns. 15. Performs outreach to members and providers as part of quality, drug utilization, and/or control initiatives. 16. Assists the Director of Pharmacy with educational opportunities for internal staff, members, healthcare providers, and pharmacy students/interns/residents. 17. Identifies and implements initiatives to enhance clinical outcomes and improved medication selection, utilization, and adherence. 18. Serves as a resource for other UPHP departmental personnel related to pharmacy program procedures, processes, and initiatives. 19. Assures required licensure continuing education requirements are fulfilled as required for maintaining a Michigan registered pharmacist license. 20. Attends and participates in organizational and departmental meetings as required. 21. Maintains confidentiality of client data. 22. Performs other related duties as assigned or requested. POSITION QUALIFICATIONS: Education: Required: Pharmacy degree Requirement: Michigan licensure to practice without restriction Experience: Minimum: Two (2) years of pharmacy practice experience required Preferred: Managed care or PBM experience Clinical experience with focused patient and physician initiatives Required Skills: Keyboarding proficiency Working knowledge of MS Office (Word, Excel, & Outlook) Excellent human relation and oral/written communication, including public speaking Excellent organizational, prioritization, and problem-solving abilities Excellent attention to detail Excellent self-management abilities Composition and proofreading abilities Electronic transfer of files/documents Experience in interpreting data from multiple sources Desired Skills: Advanced experience with Microsoft Excel functionality (e.g., Pivot table, VLOOKUP, mail-merge, etc.) Knowledge of MS PowerPoint The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotion standards, but as general guidelines that should be considered along with other job-related selection or promotional criteria. Physical Requirements: [This job requires the ability to perform the essential functions contained in the description. These include, but are not limited to, the following requirements. Reasonable accommodations may be made for otherwise qualified applicants unable to fulfill one or more of these requirements]: Ability to enter and access information from a computer Ability to access all areas of the UPHP offices Occasionally lifts supplies/equipment Prolonged periods of sitting Manual dexterity Working Conditions: Works in office conditions, but occasional travel may be required Exposure to situations requiring exceptional interpersonal skills or periods of intense concentration Subject to many interruptions Occasionally subjected to irregular hours

Responsibilities

The pharmacist is responsible for managing pharmacy functions in compliance with health plans and regulatory standards, while also supporting the pharmacy director in various initiatives. Key duties include processing prior authorizations, conducting drug utilization reviews, and collaborating with healthcare professionals.