Univera HealthСare
Rochester, NY
Job Description: This position helps support the health plan's comprehensive medication management program through proactive identification of high-impact members who are utilizing high-cost specialty medications. The role plays a critical part in executing pharmacy-driven cost reduction strategies, including support of stop-loss initiatives, while ensuring clinically appropriate and member-centered care in collaboration with providers, members, pharmacies, and internal teams. Under the direction of Pharmacy Care Coordination leadership, this role is responsible for evaluating cost effective treatment regimes, with a focus on optimizing specialty medication use, improving member outcomes, and reducing total cost of care. Essential Accountabilities: Level I Utilizes prescription and medical claim data to generate clinical recommendations and conduct comprehensive medication reviews for members, with a focus on high-cost specialty therapies and complex drug regimens....