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Highmark Blue Cross Blue Shield
Managed Care Pharmacy Residency Program
Program Description:
The Managed Care Residency at Highmark will provide a unique environment that grants
exposure to a multifaceted approach to managed care pharmacy, including clinical management,
sales, operations, and scholarly activities. The resident will be an integral part of the clinical team
and will participate in virtually all of the daily clinical activities and operations as the full-time
pharmacists, such as performing clinical reviews, policy writing, formulary updates, and
Medication Therapy Management for Medicare Part D. Furthermore, the resident will be
expected to present professional posters at a national meeting of managed care organizations
and/or publish articles in peer-reviewed professional journals. Required and elective rotations will
provide the resident with exposure to diverse experiences such as specialty pharmacy, sales and
marketing, regulatory and compliance, contracting and manufacturer relations, Senior Products,
journal clubs, new drug presentations, direct patient care, and various teaching opportunities.
Objectives:
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Develop a detailed understanding of the managed care business and the
potential roles of pharmacists within the managed care setting.
Gain an understanding of prescription drug benefit design, including an
understanding of the formulary process and components of different types of
formularies (open, closed, multi-tiered).
Develop exceptional written and verbal communication skills, demonstrated
through daily professional interactions; preparing provider, member, and group
communications; oral presentations; poster presentations; and/or article
publication.
Demonstrate an ability to perform an evaluation of both a new medication as well
as a class review based on efficacy, safety, unique value, and cost parameters
utilizing drug information skills.
Develop criteria used to evaluate a request for non-formulary drug coverage,
evaluate a prior authorization request, or evaluate a managed prescription drug
coverage request.
Participate in the clinical evaluation process for determining whether coverage for
non-formulary medications and/or prior authorizations will be approved.
Gain an understanding of regulatory and legislative issues impacting the health
care industry with a focus on managed care.
Gain an understanding of the benefit consultant’s role in evaluating trends in
current benefit structures and opportunities for managing benefits.
Rotations:
Drug Utilization Review/Pharmaceutical Management
Medication Therapy Management
Formulary Monograph and Policy Development
Member, Group, and Provider Communications
Specialty Pharmacy
Contracting
Pipeline Management
Medicare Part D file management
Provider detailing
Sales and Marketing
Other opportunities identified jointly by the resident and Highmark
Case Management/Medical Policy
Contact Information:
Prospective candidates should forward curriculum vitae and letter of intent (detailing experience,
background, reason for pursuing a managed care residency, and career goals) to:
Eric Culley, PharmD
Manager of Clinical Pharmacy Services
Highmark Blue Cross Blue Shield
120 Fifth Avenue, Ste 1812
Pittsburgh, PA 15222
In addition, 3 letters of recommendation will be required at the time of interview.
Interview Process:
Interviews are tentatively scheduled to begin in late January. Please note that Highmark is
participating in the Resident Matching Program.