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The Health Outcomes Pharmacist is a vital member of Peak Health’s clinical and quality operations, responsible for optimizing medication use and improving health outcomes across the member population. This position supports care management and quality initiatives by providing clinical pharmacy expertise, conducting medication reviews, addressing pharmacy benefit inquiries, and identifying and resolving medication-related issues.

Working closely with interdisciplinary care teams, providers, and internal stakeholders, the Health Outcomes Pharmacist helps ensure safe, effective, and evidence-based medication therapy, with a particular focus on members with chronic or complex conditions. The pharmacist supports regulatory and quality performance efforts, including HEDIS and Medicare Star Ratings, by promoting medication adherence, identifying gaps in care, and contributing to the evaluation of outcomes and interventions.

The ideal candidate will bring a strong foundation in clinical pharmacotherapy, knowledge of Medicare and Medicaid pharmacy benefit regulations, and experience in managed care or population health. Success in this role requires analytical skills, attention to detail, and the ability to collaborate across departments to meet organizational goals related to quality, cost, and member experience.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Must possess current license as required by state board where services will be provided: 
PA: Pharmacist license through the Pennsylvania State Board of Pharmacy 
MD: Pharmacist license through the Maryland Board of Pharmacy 
OH: Pharmacist license through the Ohio Board of Pharmacy 
WV: Pharmacist license through the West Virginia State Board of Pharmacy            
Remote Workers only: Must additionally hold current Pharmacist license issued by state of residence.

EXPERIENCE:

1. Three (3) years experience working in a managed care, health plan, or population health environment.

2. Three (3) years proven experience with quality measurement programs including HEDIS, Stars Ratings, and Medicare Advantage and Medicaid regulations.

3. Three (3) years in clinical pharmacy practice.

PREFERRED QUALIFICATIONS:

EXPERIENCE:

1. Managed Care Residency, Ambulatory Care Residency, OR Board Certification in Pharmacy specialties such as Board Certified Pharmacotherapy Specialist (BCPS), Board Certified Ambulatory Care Pharmacist (BCACP), or Board Certified Geriatric Pharmacy (BCGP).

2. In-depth knowledge of Medicare Part D and Medicaid pharmacy benefits.

3. Experience collaborating with interdisciplinary care teams, case managers, and providers to optimize medication use.

4. Experience in Medication Therapy Management (MTM), proficiency in utilizing MTM platforms and tools.

5. Proficiency with electronic health records (EHR) systems, such as EPIC.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. Provide evidence-based clinical recommendations to optimize medication use for members with complex conditions or chronic diseases and reduce total cost of care.

2. Conduct medication reviews, identify drug therapy problems, and collaborate with providers and care managers on appropriate interventions.

3. Partner with care management, disease management, and interdisciplinary care teams to support medication optimization and achieve desired health outcomes.

4. Contribute to the development and implementation of member care plans, especially for high-risk or high-cost populations.

5. Serve as a subject matter expert for pharmacy benefits, including formulary, prior authorization, and step therapy protocols.

6. Respond to pharmacy-related inquiries from providers, members, and internal departments to ensure clarity and appropriate benefit utilization.

7. Support initiatives related to HEDIS, CMS Star Ratings, and other quality performance metrics involving medication use (e.g., adherence, statin use, MTM).

8. Identify and address gaps in care through targeted outreach and interventions.

9. Educate providers on formulary changes, prescribing best practices, and opportunities for improved medication utilization.

10. Conduct member outreach as needed to support medication understanding, adherence, and wellness.

11. Ensure compliance with state and federal regulations related to pharmacy services, including Medicare Part D and Medicaid guidelines.

12. Assist with reporting and documentation to support audits, accreditation, and internal reviews.

13. Analyze pharmacy and medical claims data to identify trends, risks, and opportunities for improvement.

14. Track and report on clinical outcomes, program impact, and performance benchmarks.

15. Participate in the design and execution of pharmacy-related quality improvement programs and pilot projects.

16. Contribute to the continuous improvement of pharmacy and care coordination services across the organization.

17. Engage in relevant boards, committees, task forces, and organizational meetings, as well as other designated activities.

18. Licensure in multiple states may be required, depending on evolving business needs and regulatory requirements.

19. Perform other related duties and responsibilities as assigned.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Ability to stand and walk short distances for eight or more hours.

2. Frequent bending, stooping, or stretching.

3. Ability to lift 30 pounds and push 50 pounds.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment.

2. Some travel may be required to provider offices and offsite meetings.

SKILLS AND ABILITIES:

1. Ability to work under stressful working conditions.

2. Ability to handle and maintain confidential information.

3. Ability to work cooperatively as a team member with articulate oral and written communication and presentation skills.

4. Ability to work in a fast-paced and rapidly changing environment with attention to detail.

5. Ability to work proactively and independently to research and resolve complex issues.

6. Experience with regulatory and accreditation standards.

7. Ability to apply relevant laws, regulations, requirements, and policy standards.

8. Extensive working knowledge of Microsoft Office applications including Excel, Outlook, PowerPoint, Teams, electronic medical records, and MTM platforms.

Additional Job Description:

OCTOBER 2026 START DATE

• will be on-site rotation at Peak Health Welcome Center (Morgantown, WV) 1-2 times/month subject to change
• Heavily focused on new DSNP line of business so

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Exempt)

Company:

PHH Peak Health Holdings

Cost Center:

2405 PHH Medication Management