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    Clinical Pharmacist Ii Formulary Management

    Wellsense Health Plan
    2+ years
    Not Disclosed
    Remote, USA
    10 Dec. 11, 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 Title: Clinical Pharmacist II, Formulary Management (Remote)
    Company: WellSense Health Plan
    Location: Remote
    Job ID: 2015430
    Employment Type: Full-Time/Regular

    About WellSense Health Plan:
    WellSense Health Plan is a growing nonprofit health insurance company dedicated to providing quality health plans and services to over 740,000 members across Massachusetts and New Hampshire. With a 25-year history, we serve our members through Medicare, Individual and Family, and Medicaid plans. We are committed to fostering diversity and inclusion in both our staff and the communities we serve.

    Job Summary:
    The Clinical Pharmacist II, Formulary Management, will report to the Manager of Clinical Pharmacy and will oversee the Plan’s formularies for Medicaid and Commercial lines of business. In addition, this role will support clinical initiatives aligned with the Plan’s strategic growth objectives, ensuring the formulary remains up to date with clinical guidelines and regulatory requirements.

    Key Responsibilities:

    • Develop formulary management strategies for drug coverage, step therapy protocols, quantity limits, and prior authorization guidelines.
    • Recommend formulary placements for existing or new drugs to maximize benefits based on market trends, rebates, and clinical guidelines.
    • Analyze pharmacy cost trends and collaborate with finance, actuarial teams, and PBM partners to optimize pharmacy benefit design.
    • Review annual Authorization criteria, Quantity limits, and formularies to ensure compliance with NCQA and regulatory guidelines.
    • Act as a resource for drug information and provide pharmacy business support for internal and external stakeholders.
    • Coordinate the Pharmacy and Therapeutics Committee’s activities, including clinical and financial reviews, formulary development, and policy updates.
    • Assist in clinical pharmacy reporting to meet contractual requirements.
    • Ensure all pharmacy management programs meet applicable NCQA and utilization management regulations.
    • Work with ACO partners and providers to develop strategies for reducing pharmacy costs.
    • Lead efforts in creating marketing materials for member and provider communications.
    • Assist in the development of quality improvement projects and metrics to enhance care outcomes.
    • Maintain current and accurate formulary details on the Plan’s website, including prior authorization criteria and formulary links.
    • Support utilization management initiatives as needed.

    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 of prior managed care experience (Required)
      • Pharmacy & Therapeutics Committee experience (Required)
      • 5+ years of prior managed care experience (Preferred)
    • Certification/Conditions:
      • Current unrestricted licensure as a pharmacist in any U.S. state or territory (Required)
      • Pre-employment background check (Required)

    Competencies, Skills, and Attributes:

    • Extensive knowledge of drug products, pharmacokinetics, therapeutics, and disease states.
    • Strong communication and presentation skills, with proficiency in MS PowerPoint.
    • Excellent organizational and time management skills.
    • Ability to multitask in a fast-paced environment.
    • Strong analytical and clinical problem-solving skills.
    • Proficiency in MS Outlook, Word, Excel, and other data entry applications.

    Working Conditions:

    • Primarily remote with occasional travel (<5%).
    • Fast-paced office environment with no physical effort required.

    Our Investment in You:

    • Full-time remote work.
    • Competitive salary and excellent benefits.

    Equal Opportunity Employment:
    WellSense is committed to equal opportunity and diversity in the workplace, offering opportunities regardless of race, color, religion, sex, national origin, sexual orientation, gender identity, disability, or protected veteran status. We participate in the E-Verify program to verify employment eligibility.

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