Managed Care Pharmacist - Medical Affairs - The Health Plan (8a - 8p) Variable 8-10 Hr. Shift (Hybrid Remote/ On-Site)

Position: Managed Care Pharmacist - Medical Affairs - The Health Plan (8a - 8p) Variable 8-10 Hr. Shift (Hybrid Remote/ On-Site)

Job ID: 166872

Location: US-TX-Houston


Talent Area: Pharmacy

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 8p / Full Time / Variable 8-10 Hr. Shift (Hybrid Remote/ On-Site)

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.   To join our community of 14,000+ dedicated team members, visit for career opportunities. You can also learn more about our amazing culture at   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.


We are searching for a Managed Care Pharmacist -- someone who works well in a fast-paced setting. In this position, you will play a vital role within the Pharmacy department at Texas Children's Health Plan. This individual will work closely with the leadership team and other key personnel to execute clinical and audit oversight activities. The pharmacist will also serve as a resource and mentor to members, network providers, employees, and external collaborators.


Think you’ve got what it takes?

Responsibilities :

· Utilize practice knowledge and skills to execute clinical initiatives for the health plan

· With guidance from leadership, complete the required tasks to move clinical projects and pharmacy initiatives forward

· Use data to measure quantifiable outcomes and interventions

· Report progress to leadership team

· Participate in the completion of medication appeals

· Review complex clinician administered drug prior authorizations or fair hearing requests as needed

· Complete clinical and compliance tasks

· Participate in the education of parents/members, providers, employees, and pharmacy students

· Participate in the education and training of health plan employees, pharmacy students, and non-pharmacy personnel

· Develop an educational program and a plan and incorporate into pharmacist’s routine increasing their clinical knowledge

· Collaborate effectively with other members of the Texas Children’s system to ensure best outcomes for members

· Maintain patient confidentiality as documented by lack of complaints and peer review

· Perform other essential functions


Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s, unless approved for a medical or religious exemption.


· Bachelor’s degree in Science in Pharmacy, Or

· Pharmacy doctorate required

· RPH Pharmacist certification in the state of Texas required

· 1 year of experience in PGY1 Managed Care Pharmacy residency preferred

· 3 years’ experience in managed care at a health plan or PBM working in utilization management, analytics, formulary management, and/or clinical literature preferred

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