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Clinical Pharmacist Ii Formulary Management

3+ years
$118,400 - $141,400
10 Dec. 4, 2024
Job Description
Job Type: Full Time Remote Education: B.Sc./ M.Sc./ M.Pharm/ B.Pharm/ Life Sciences Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

Job Title: Clinical Pharmacist II – Formulary Management

Employer: WellSense Health Plan
Location: Remote (OR, USA)


Compensation

  • Annual Salary: $118,400 - $141,400 (Estimated)
  • Employment Type: Full-Time, Remote

Job Summary

As a Clinical Pharmacist II – Formulary Management, you will oversee and manage formularies for Medicaid and Commercial lines of business, aligning them with clinical and strategic growth goals. This role involves collaboration with internal and external teams to enhance formulary strategies, ensure compliance, and optimize pharmacy costs.


Key Responsibilities

  • Formulary Management:

    • Develop and implement strategies for drug coverage, step therapy protocols, quantity limits, and prior authorization guidelines.
    • Recommend formulary placements based on clinical guidelines, market trends, and rebate opportunities.
  • Regulatory Compliance:

    • Ensure formularies meet NCQA, state, and contractual utilization management regulations.
    • Conduct annual reviews of authorization criteria and formulary standards.
  • Data Analysis and Reporting:

    • Analyze pharmacy cost trends and collaborate with finance and actuarial teams.
    • Support clinical pharmacy reporting for contractual and regulatory requirements.
  • Stakeholder Collaboration:

    • Act as a drug information resource for internal and external stakeholders.
    • Coordinate Pharmacy and Therapeutics Committee activities, including financial and clinical reviews.
  • Communication and Strategy:

    • Present cost-reduction strategies to ACO partners and assist with provider communication.
    • Lead the creation of marketing materials and member/provider communication related to pharmacy.
  • Quality Improvement:

    • Develop and maintain quality improvement projects, metrics, and outcomes.
    • Ensure the Plan’s website content is accurate and up to date.

Qualifications

Education:

  • Bachelor of Science in Pharmacy (required).
  • Doctor of Pharmacy (preferred).
  • Residency training and Board of Pharmaceutical Specialties (BPS) certification in Pharmacotherapy (preferred).

Experience:

  • 3+ years in managed care pharmacy (required).
  • 5+ years of managed care experience (preferred).
  • Pharmacy & Therapeutics Committee experience.

Licensure:

  • Current unrestricted U.S. pharmacist license.

Skills & Competencies:

  • Strong knowledge of drug products, medical therapeutics, pharmacokinetics, and disease states.
  • Proficiency in Microsoft Office (Outlook, Word, Excel, PowerPoint).
  • Excellent communication, presentation, organization, and time management skills.
  • Ability to multitask in a fast-paced environment.

Benefits of Joining WellSense Health Plan

  • Fully remote work environment.
  • Competitive salaries with excellent benefits.
  • Opportunity to join a growing regional health insurance provider with a 25-year history of success.

Apply now to become a key contributor to WellSense Health Plan’s formulary management and make a meaningful impact on patient care and cost management.