Clinical Pharmacist Ii

It’s an exciting time to join the 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.

Reporting to the Senior Director of Pharmacy Services, the Clinical Pharmacist II is primarily responsible for supporting WellSense’s clinical and quality management programs and formulary management activities. The clinical and quality management programs are targeted towards improving health outcomes through improving performance for key quality measures and/or drug utilization management requirements in support of contractual, regulatory, and accreditation requirements within the Medicaid and Commercial lines of business. The Plan’s quality programs aims to impact patient care through improving self-care and wellness, promoting health activities, increasing medication adherence, and optimizing treatment plans, among the various goals. In this role, the Clinical Pharmacist II will design, implement, monitor, maintain and leverage data and analytical skills to measure program outcomes. This role will also provide formulary management supports which include developing policies, conducting new drug reviews, formulating coverage recommendations, participate at Pharmacy & Therapeutics (P&T) Committees, and support formulary implementation activities. Other elements of this role include liaising with other clinical business areas to provide clinical care for eligible members, resolving member-level barriers or gaps in care, serving as a key point of contact for high risk populations, and developing innovative utilization and/or management programs for high- cost, complex disease states supported by data evaluations. In this role, the individual must be able to plan, organize, and prioritize work to ensure accurate and timely completion. The Clinical Pharmacist II must have a well-versed understanding of regulatory, contractual and accreditation requirements relative to the responsibilities listed and exhibit clear communication and active collaboration to be successful in this role.

Our Investment in You:

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

Key Functions/Responsibilities:

• Works in conjunction with the pharmacy management team on quality improvement initiatives that are targeted towards quality incentives, regulatory performance standards, and meet contractual requirements.

• Perform tasks that support requirements to meet NCQA standards and other state and federal regulations and contracts

• Directly interact with a multi-disciplinary team that includes, but is not limited to, Pharmacists, Medical Directors, Providers, Care Managers, Population Health Liaisons, and Members.

• Design, implement, maintain, and monitor quality initiatives

• Responsible for the administration of the clinical programs or initiatives such as medication assessments to address indications, effectiveness, safety and adherence as assigned

• Perform data analysis and produce performance metrics to demonstrate program outcomes

• Serve as a point of contact for specified high-risk populations and provide oversight to the quality of services these populations receive; has the ability to identify potential medication-related issues and is able to resolve, facilitate, or escalate to Managers or clinicians

• Collaborates with areas such as Care Management and Population Health to provide pharmacy support in identifying, resolving and preventing medication related problems. May include direct outreach and performing one-on-one consultations with high risk members and providers.

• Performs complex research and analysis related to prescription drugs and their applications in support of the formulary management and prior-authorization programs.

• Develops clinical policies and formulary recommendations that align with the Plan’s management strategies by line of business; presents at P&T Committee meetings.

• Responsible for formulary implementation activities to complete the P&T approved recommendations

• Develops and maintains knowledge on quality-related contractual, accreditation, and industry-standard quality measures.

• Works with the (PBM) and internal departments to identify areas of potential cost-saving and quality improvement initiatives.

• Participates in Committees as a Pharmacy representative

• Supports ad-hoc projects and audit activities as needed

• Other duties as assigned

Qualifications:

Education:

• Bachelor of Pharmacy
• Doctor of Pharmacy preferred

Experience:

• Five or more years of clinical experience in a clinical professional setting required or completion of an accredited residency program in Managed care

Experience Preferred/Desirable:

• Three or more years of managed care experience

• Two or more years of clinical program development or population-based health management

• Formulary management experience involving evidenced-based research and development of coverage recommendations

Certification or Conditions of Employment:

• Valid unrestricted pharmacy license in the U.S.A

• Successful completion of pre-employment background check

Competencies, Skills, and Attributes:

• Excellent Customer Service skills

• Experience providing patient care and assisting members and/or providers with inquiries

• Ability to effectively collaborate with health care providers and all members of the interdisciplinary team

• Strong organizational, problem solving, communication, and interpersonal skills

• Excellent written and oral communication skills required.

• Must have data and analytic experience

• Has attention to detail in documentation and data entry

• Must be able to multitask and be results oriented

• Demonstrated time management skills and be able to function independently

• Effectively work in a matrix environment to accomplish work across multiple teams in the health plan and health system

• Experience with standard Microsoft Office applications, particularly MS Outlook and MS Word, and other data entry-processing applications.

Working Conditions and Physical Effort:

• Regular and reliable attendance is an essential function of the position.

• Ability to work in a fast-paced environment.

• Work is normally performed in a typical interior/office work environment.

• No or very limited physical effort required. No or very limited exposure to physical risk.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.