The University of Pittsburgh Medical Center (UPMC) Health Plan is the second largest health insurer in western Pennsylvania.  The National Committee for Quality Assurance and U.S. News & World Report listed UPMC Health Plan as the top-ranked health plan in Pennsylvania, and one of the top-20 health plans in the United States. The Health Plan is the only Pennsylvania plan to receive five stars in the categories of "Prevention" and "Treatment," and is the highest-ranked managed care company in the nation for breast cancer screening, for the second consecutive year.

The integration of resources from the Health Plan, UPMC Health System, Community Care Behavioral Health (CCBH), and the University of Pittsburgh School of Pharmacy, creates a challenging environment for the Managed Care Residency. Highly motivated pharmacy residents are provided the opportunity to apply safe and effective, evidenced-based medicine practices to individual patients and in populations throughout the Health Plan. UPMC Health Plan provides access to the complete health management of the plan members (i.e. inpatient admissions, out-patient laboratory values, diagnosis, etc.).

The training site for this residency is the Pharmacy Service Department of the Health Plan, located within the city of Pittsburgh.  The pharmacy department is comprised of two main areas: clinical and operations.  The clinical portion of the pharmacy department supports the development of pharmacy benefits for three distinct lines of business: Commercial, Medical Assistance and Medicare, with the new addition of the Children’s Health Insurance Program (CHIP) under the Commercial line of business.  The Managed Care resident will create criteria for drug utilization reviews and evaluations, develop clinical intervention activities in conjunction with disease management programs, participate in Health Plan Pharmacy and Therapeutics committee activities, and assist in formulary management and policy development. UPMC Health Plan develops and implements evidence-based formularies in order to provide high quality, cost-effective medicine to its members. This process occurs by working with physician sub-committees, the Pharmacy and Therapeutics Committee and the Quality Improvement Committee.  In addition, the operational side of the department implements the pharmacy benefits via the pharmacy benefit manager, and responds to provider and physician requests through the pharmacy call center.  Residents also have the opportunity to do off-site rotations with a pharmacy benefits manager.

The residency is affiliated with the University of Pittsburgh.  Residents will participate in journal clubs, present seminars, and complete a research project.  In addition, residents receive an Adjunct Instructor position with opportunities for teaching, research and other scholarly activities.

The ultimate goal of the program is to enable residents to become competent in the knowledge, skills, and attitudes required to optimize pharmacotherapy outcomes and provide a high level of patient care to diverse populations in a managed care environment.

Residency Objectives:

• Develop an understanding of the evolution of managed care, the various managed care partnerships/relationships and the structure and processes of care delivery within a managed care environment.
• Participate in the ongoing modification of drug utilization evaluation (DUE)/drug utilization review (DUR) programs in a managed health care system.
• Participate in the components of disease management: identification of need, development, implementation and assessment of treatment guidelines/protocols related to individual and population based patient care.
• Demonstrate professionalism and effective communication skills in all components of managed care pharmacy through presenting effective platform/seminar presentations, an Eastern States platform, submitting and presenting a poster to the AMCP Annual Meeting, in-service presentations to professionals, appropriate documentation, and daily interactions with other managed care professionals.
• Provide effective education lecturing to future health care professionals in the pharmacy curriculum, facilitating small group sessions in the pharmacy curriculum, serving as a preceptor on a managed care rotation for pharmacy students, and in-service presentations within the Health Plan (i.e. call center, health management).

Apply clinical and outcomes research concepts through attending all of the resident research modules, completing a research project, and publishing the results in a peer reviewed journal.

Program Director: Jessica Daw, PharmD

Block Core Rotations

• Drug Use and Medication Therapy Management
• Formulary and Utilization Management
• Drug Information
• Pharmacy Benefits Manager
• Managed Care Marketing, Communications, and Account Management
• Community Care Behavioral Health
• Operations
• Commercial, Medicaid, and Medicare
• Clinical education consultant industry

Application Process

Eligible candidates will have a PharmD degree and be eligible for pharmacy licensure in the state of Pennsylvania.  Prior completion of a Pharmacy Residency is recommended but not required for consideration. An onsite interview is required.  Application materials include: curriculum vitae, letter of intent, college transcript, list of three references, and three letters of recommendation sent separately (at least one of these letters must be from a clinical rotation experience).  All application materials must be postmarked by no later than January 10 and should be forwarded to:

Jessica R. Daw, Pharm D
Managed Care Pharmacy Residency Coordinator
Clinical Pharmacy Specialist
UPMC Health Plan
Two Chatham Center
112 Washington Place, 17th floor
Pittsburgh, PA 15219

Phone:  (412) 454-7822
E-mail:  dawjr@upmc.edu

Residency Program

Duration/Type: 12 months
Number Positions: 1
Application Deadline: January 10
Starting Date: July 1
Estimated Stipend: $32,000
Benefits: Health, dental, eye care, life and disability available; vacation time allotted, professional travel and stipend available, no weekends or holidays, no staffing requirements in a pharmacy
Interview Required: Yes
Training Site Type: Managed Care Organization
Owner/Affiliates: Private
Model (type): Managed Care Organization
Professional Staff: 10