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The health care industry is evolving and Wellmark is working to help change it for the better.
Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we've built our reputation on over 80 years' worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors-our members. If you're passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today!
Learn more about our unique benefit offerings here.
You can also learn more about working at Wellmark here.
Job Description
Use your strengths as Director of Pharmacy Utilization Management at Wellmark!
About the role: As Director of Pharmacy Utilization Management (UM), you will drive the vision and strategic direction for Pharmacy UM at Wellmark. You will be a key player in building out the team and effectively onboarding skilled, productive Pharmacy UM team members. As a leader of others, you will directly impact the success, growth, and development of team members by setting clear expectations, coaching to each team member's strengths, and fostering a team-centric work environment. Being a role model in behaviors that demonstrate Wellmark's Leader Success Expectations and inclusion are essential. You will serve as a subject matter expert in Pharmacy UM and will collaborate regularly with internal and external stakeholders. Success in this role is providing Wellmark members and providers best in class, accurate, timely, and seamless prior authorization experience. This includes continuous focusing on process improvement in UM technology and team workflow management to optimize long-term strategy.
What does it take to make the cut? You believe health care can be better and are passionate about finding ways to influence this important work. You are proactive, analytical, innovative, and partner effectively with all levels within the organization and externally. You are also an experienced people-leader who believes mentorship and team member growth is the key to success. You love to teach and understand the benefits of transparent, dedicated leadership, because your team members' individual achievements mean success for Wellmark. You are committed to compliance and implementing drug strategies that result in optimizing maximum affordability and/or earnings for clients and the plan, as well as best clinical outcomes and experience for members and providers.
Qualifications
Required:
Preferred:
Additional Information
a. Lead, coach, and mentor a team of UM Pharmacists and Pharmacy Support Teams. Manages and communicates UM review work flows.
b. Provide analytical approach to appropriate staffing and optimize team performance to meet goals.
c. Build and maintain process to achieve, meet, and surpass standards for UM review (NCQA, HEDIS, CMS, etc.). Accountable to meet UM compliance national and state standards.
d. Lead pharmacy quality improvement and UM workgroup and/or committee, as applicable.
e. Partner with Pharmacy Operations team to implement and test all, or at least key UM programs internally and with PBM partner.
f. Partner with the Director, Pharmacy Clinical Program to develop, manage, and implement drug preference and clinical policies & procedures through the use of evidenced-based medicine such as compendia, clinical guidelines, and peer review medical literature, particularly for the development of PA criteria pathways/decision sets.
g. Partner with internal Wellmark team(s) on pharmacy appeals and other requests, as applicable.
h. Partner with internal and external teams to develop reports to track UM performance.
i. Participate and/or assist with Pharmacy & Therapeutics Committee, Formulary Assessment Committee, Quality Improvement and other committee meetings as appropriate.
j. Help develop and implement clinical cost of care strategies and quality initiatives as needed to help reduce pharmacy cost and utilization.
k. Participate in clinical training and development of training documentation for internal and external customers on Pharmacy UM Operations.
l. Serve as the clinical resource and consultant in areas of applicable pharmacy and medication management.
m. Support medical management and clinical/quality initiatives across the organization.
n. Act as resource for other Wellmark teams in the review of clinical cases involving dosing, schedule, vial size (dose optimization), clinical trials, therapeutic substitution, and provider/practice inquiries. Participates in clinical review meetings with internal and external customers.
o. Collaborate with Data Analytics Team to provide applicable clinical data reporting for internal and external clients.
p. Respect and maintain HIPAA confidentiality guidelines for UM team.
q. Perform other duties as assigned.
This job requires a non-compete agreement.
An Equal Opportunity Employer
The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.
Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at careers@wellmark.com
The health care industry is evolving and Wellmark is working to help change it for the better.
Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we've built our reputation on over 80 years' worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors-our members. If you're passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today!
Learn more about our unique benefit offerings here.
You can also learn more about working at Wellmark here.
Job Description
Use your strengths as Director of Pharmacy Utilization Management at Wellmark!
About the role: As Director of Pharmacy Utilization Management (UM), you will drive the vision and strategic direction for Pharmacy UM at Wellmark. You will be a key player in building out the team and effectively onboarding skilled, productive Pharmacy UM team members. As a leader of others, you will directly impact the success, growth, and development of team members by setting clear expectations, coaching to each team member's strengths, and fostering a team-centric work environment. Being a role model in behaviors that demonstrate Wellmark's Leader Success Expectations and inclusion are essential. You will serve as a subject matter expert in Pharmacy UM and will collaborate regularly with internal and external stakeholders. Success in this role is providing Wellmark members and providers best in class, accurate, timely, and seamless prior authorization experience. This includes continuous focusing on process improvement in UM technology and team workflow management to optimize long-term strategy.
What does it take to make the cut? You believe health care can be better and are passionate about finding ways to influence this important work. You are proactive, analytical, innovative, and partner effectively with all levels within the organization and externally. You are also an experienced people-leader who believes mentorship and team member growth is the key to success. You love to teach and understand the benefits of transparent, dedicated leadership, because your team members' individual achievements mean success for Wellmark. You are committed to compliance and implementing drug strategies that result in optimizing maximum affordability and/or earnings for clients and the plan, as well as best clinical outcomes and experience for members and providers.
Qualifications
Required:
- Bachelor's degree in Pharmacy OR PharmD.
- Active and unrestricted Pharmacy license in Iowa or South Dakota (individual must be licensed in the state in which they reside) or ability to obtain within 6 months from date of hire.
- 8+ years of managed care pharmacy or pharmacy residency program experience, including demonstrated coaching/mentoring experience, and broad understanding of the health care delivery system, managed care and pharmacy benefit management systems, plan design and overall operations. Minimum of 3 of those years being leadership experience in PBM or health plan pharmacy UM department.
- Demonstrated leadership experience, including building/developing high performing leaders and leaders of teams that consistently deliver value-added results.
- Humanistic approach to leadership with experience in building, leading, motivating, evaluating teams and complex programs. A collaborative leader with experience building consensus and influencing decisions through the development and maintenance of effective working relationships with executive management.
- Ability to measure, evaluate and/or improve work processes, programs, and services; ensures alignment with strategic goals.
- Self-starter able to produce quality results based off strong decision-making skills.
- Excellent analytical, problem solving, and critical thinking skills. Ability to independently make effective evidence-based decisions and coach/guide others.
- Outstanding written and verbal communication skills. Ability to effectively articulate complex information across all levels of an organization, including senior leadership and non-clinical/technical audiences. Strong presentation skills.
- Strong organization and prioritization skills. Ability to manage multiple projects simultaneously and consistently meet deadlines.
- Self-starter able to produce quality results based off strong decision-making skills.
- Effective time management and organizational skills with the ability to prioritize initiatives, align appropriate resources, clearly articulate expectations to others, and motivate teams in order to achieve success.
- Adaptable and flexible with change and also have the ability to effectively lead teams through change.
- Understanding of applicable rules, regulations, and guidelines. Must be aware of implications to department.
- Strong ability to leverage industry knowledge, technical expertise, and relationship building skills to build rapport, credibility, and collaborative partnerships with clinical peers, leaders, and stakeholders; applies skillful consulting abilities to influence corporate decisions
- Is forward-thinking, exhibits the ability to learn quickly; advocates and leads change efforts; analyzes successes and failures for improvement opportunities; enjoys challenges. Works well under pressure while remaining adaptable, open to feedback and focused during unanticipated challenges.
- Proficiency with the Microsoft Windows Office Suite, including Word and Excel.
- Travel required up to 25% to meet with vendors, clients and attend conferences.
Preferred:
- MBA or Master's degree preferred.
- Success with end-to-end management of complex programs from inception through execution and ongoing optimization.
- Strategic planning experience.
Additional Information
a. Lead, coach, and mentor a team of UM Pharmacists and Pharmacy Support Teams. Manages and communicates UM review work flows.
b. Provide analytical approach to appropriate staffing and optimize team performance to meet goals.
c. Build and maintain process to achieve, meet, and surpass standards for UM review (NCQA, HEDIS, CMS, etc.). Accountable to meet UM compliance national and state standards.
d. Lead pharmacy quality improvement and UM workgroup and/or committee, as applicable.
e. Partner with Pharmacy Operations team to implement and test all, or at least key UM programs internally and with PBM partner.
f. Partner with the Director, Pharmacy Clinical Program to develop, manage, and implement drug preference and clinical policies & procedures through the use of evidenced-based medicine such as compendia, clinical guidelines, and peer review medical literature, particularly for the development of PA criteria pathways/decision sets.
g. Partner with internal Wellmark team(s) on pharmacy appeals and other requests, as applicable.
h. Partner with internal and external teams to develop reports to track UM performance.
i. Participate and/or assist with Pharmacy & Therapeutics Committee, Formulary Assessment Committee, Quality Improvement and other committee meetings as appropriate.
j. Help develop and implement clinical cost of care strategies and quality initiatives as needed to help reduce pharmacy cost and utilization.
k. Participate in clinical training and development of training documentation for internal and external customers on Pharmacy UM Operations.
l. Serve as the clinical resource and consultant in areas of applicable pharmacy and medication management.
m. Support medical management and clinical/quality initiatives across the organization.
n. Act as resource for other Wellmark teams in the review of clinical cases involving dosing, schedule, vial size (dose optimization), clinical trials, therapeutic substitution, and provider/practice inquiries. Participates in clinical review meetings with internal and external customers.
o. Collaborate with Data Analytics Team to provide applicable clinical data reporting for internal and external clients.
p. Respect and maintain HIPAA confidentiality guidelines for UM team.
q. Perform other duties as assigned.
This job requires a non-compete agreement.
An Equal Opportunity Employer
The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.
Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at careers@wellmark.com
