Clinical Pharmacist Ii Formulary Management

5+ years

$118,400 to $141,400 Annually

Remote, USA

10 Dec. 6, 2024

Job Description

Job Type: Full Time Education: B.Sc./M.Sc./B.Pharm/M.Pharm/Life science 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

Position: Clinical Pharmacist II - Formulary Management
Location: Remote (Full-time)
Company: WellSense Health Plan

Job Summary

Join WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances. The Clinical Pharmacist II, Formulary Management is responsible for overseeing and managing the Plan's formularies for Medicaid and Commercial lines of business. Reporting to the Manager of Clinical Pharmacy, the Clinical Pharmacist II also supports clinical initiatives that enhance the Plan’s strategic growth objectives.

Our Investment in You

Full-time remote work
Competitive salary
Excellent benefits

Key Responsibilities

Formulary Development and Management:
- Participate in the development of formulary management strategies related to drug coverage, step therapy protocols, quantity limits, and prior authorization guidelines.
- Recommend the strategic placement of drugs on formularies to maximize benefits based on market trends, rebate opportunities, and clinical guidelines.
- Annually review authorization criteria, quantity limits, and formularies to ensure they meet NCQA/regulatory guidance for both Medical and Pharmacy Benefits.
Collaboration and Stakeholder Engagement:
- Act as a resource for drug information and pharmacy business support for internal and external stakeholders.
- Coordinate Pharmacy and Therapeutics Committee activities, including clinical and financial reviews, formulary development, and clinical policy creation.
- Support pharmacy benefit design and collaborate with finance, actuarial teams, and PBM partners to analyze pharmacy cost trends.
Regulatory Compliance and Reporting:
- Ensure that all pharmacy management programs comply with NCQA, state, and contractual utilization management (UM) regulations.
- Assist in the development of clinical pharmacy reports and quality improvement projects, quality metrics, and outcome measurements.
- Maintain accurate and current formulary information on the Plan’s website, including prior authorization criteria and coverage requests.
Cost Management and Strategy:
- Present strategies to decrease pharmacy costs to ACO partners and assist with provider detailing strategies for implementation.
Member and Provider Communication:
- Lead efforts in creating pharmacy-related communication materials for members and providers.

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 managed care experience (required)
Experience with Pharmacy & Therapeutics Committees (required)
5+ years of managed care experience (preferred)

Certification or Conditions of Employment:

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

Competencies, Skills, and Attributes

Extensive knowledge of drug products, medical therapeutics, pharmacokinetics, and disease states.
Strong oral and written communication skills; ability to engage at all levels of the organization and with external contacts.
Strong presentation skills and proficiency in MS PowerPoint.
Strong organizational and time management skills.
Ability to work in a fast-paced environment and manage multiple tasks.
Proficiency in Microsoft Office applications (Outlook, Word, Excel).

Why Join Us?

At WellSense Health Plan, we’re committed to ensuring our members receive the highest quality care. As part of our team, you'll have the opportunity to influence the development and management of our formularies, ensuring that the services we provide are aligned with regulatory guidelines, clinical best practices, and cost-saving opportunities. Enjoy the flexibility of remote work while making a significant impact in managed care pharmacy.

This opportunity offers a chance to join an innovative and growing health plan that values both its employees and the well-being of its members.

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Clinical Pharmacist Ii Formulary Management

Job Description

Job Summary

Our Investment in You

Key Responsibilities

Qualifications

Competencies, Skills, and Attributes

Why Join Us?

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