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    Clinical Pharmacist Ii Formulary Management

    Wellsense Health Plan
    5+ years
    $118,400 to $141,400 per year
    Remote
    10 Dec. 6, 2024
    Job Description
    Job Type: Full Time 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 Summary:

    Join WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing insurance that works for our members, regardless of their circumstances. Reporting to the Manager of Clinical Pharmacy, the Clinical Pharmacist II, Formulary Management will oversee and manage the Plan’s formularies for Medicaid and Commercial lines of business. The role supports clinical initiatives aligned with the Plan’s strategic growth objectives.

    Our Investment in You:

    • Full-time remote work
    • Competitive salaries
    • Excellent benefits

    Key Functions/Responsibilities:

    • Participate in developing formulary management strategies, including drug coverage, step therapy protocols, quantity limits, and prior authorization guidelines.
    • Recommend the strategic placement of existing or new drugs on the formulary based on market trends, rebate opportunities, and clinical guidelines.
    • Analyze pharmacy cost trends and collaborate with finance, actuarial teams, and the PBM partner to support pharmacy benefit design.
    • Annually review Authorization criteria, Quantity limits, and formularies to ensure compliance with NCQA/regulatory guidance on both Medical and Pharmacy Benefits.
    • Act as a resource for drug information and Pharmacy business support for key stakeholders.
    • Review clinical policies and ensure that clinical practice guideline changes are reflected.
    • Coordinate the activities of the Plan’s Pharmacy and Therapeutics Committee, including clinical and financial reviews of drugs, formulary development, and clinical policy creation.
    • Assist with clinical pharmacy reporting related to the Plan’s contractual requirements.
    • Ensure pharmacy management programs comply with NCQA, state, and contractual utilization management regulations.
    • Maintain formulary consistency with current standards of medical care and medical necessity.
    • Present strategies to reduce pharmacy costs to ACO partners and support provider detailing strategies for successful implementation.
    • Lead marketing efforts for pharmacy-related member and provider communication materials.
    • Assist in developing and maintaining quality improvement projects, metrics, and outcome measurements.
    • Ensure accurate implementation of the Plan’s formularies in accordance with regulatory and contractual requirements.
    • Maintain the Plan’s website, ensuring up-to-date prior authorization criteria, formulary, and coverage request instructions.
    • Support utilization management initiatives as needed.
    • Regular and reliable attendance is essential for this position.

    Qualifications:

    Education:

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

    Experience:

    • 3+ years of prior managed care experience
    • Pharmacy & Therapeutics Committee experience

    Preferred Experience:

    • 5+ years of prior managed care experience

    Certification or Conditions of Employment:

    • Pre-employment background check
    • Current unrestricted licensure as a pharmacist in any U.S. state or territory

    Competencies, Skills, and Attributes:

    • Extensive knowledge of drug products, medical therapeutics, pharmacokinetics, and disease states
    • Strong oral and written communication skills; ability to interact with all levels of the organization and external contacts
    • Strong presentation skills, particularly with MS PowerPoint
    • Demonstrated strong organization and time management skills
    • Ability to work in a fast-paced environment and multitask
    • Experience with standard Microsoft Office applications, including MS Outlook, MS Word, MS Excel, and other data entry processing applications

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