Clinical Pharmacist I (Utilization Management)

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.

Job Summary:

Reporting to the Manager of Pharmacy Services, the Clinical Pharmacist I is primarily responsible for the pharmacy utilization management (UM) activities, including review of all pharmacy prior authorization requests, oversight of the UM activities of the Pharmacy Services support staff, and maintenance of existing pharmacy UM programs. In addition, the Clinical Pharmacist I supports the department by coordinating the activities of the health plan's pharmacy benefits manager (PBM) and formulary advisory committees (Pharmacy and Therapeutics Committee). The Clinical Pharmacist I may also participate in care management activities such as MTM, case reviews and such, as needed.

Our Investment in You:

* Full-time remote work

* Competitive salaries

* Excellent benefits

Key Functions/Responsibilities:

* Ensure that pharmacy prior authorization decisions are consistent with covered benefits, quality of care and medically necessity.

* Ensure that pharmacy prior authorization requests and decisions are properly evaluated, documented and meet all applicable utilization management turn-around times.

* Responsible for insuring pharmacy programs meet applicable industry, regulatory, accreditation and contractual standards or laws.

* Researches new prescription drugs or new applications of existing drugs and develops prescription drug use recommendations.

* Works with the (PBM) to identify areas of potential cost-saving and quality improvement.

* Gathers clinical and financial information for presentation to the health plan's Pharmacy and Therapeutics Committee.

* Participates on clinical committees as necessary.

* Conducts medication reconciliation outreach phone calls to members enrolled in care management programs.

Qualifications:

Education:

* Licensed in the state of Massachusetts as a Pharmacist.

* Bachelor of Pharmacy.

* Pharmacy & Therapeutics Committee experience preferred.

* Doctor of Pharmacy preferred.

Experience:

* 1-2 year's clinical experience.

* Pharmacy & Therapeutics Committee experience preferred.

* Managed Care experience preferred.

Required Licensure, Certification or Conditions of Employment:

* Valid unrestricted Massachusetts state pharmacy licensure.

Competencies, Skills, and Attributes:

* Extensive knowledge of drug products, medical therapeutics, pharmacokinetics, and disease states.

* Must be proficient in Microsoft Office.

* Strong written and verbal skills.

* Demonstrated ability to review & analyze data.

Working Conditions and Physical Effort:

* Occasional travel (<5%) may be required.

* On call coverage may be required.

Compensation Range

$88,500 - $128,500

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Note: This range is based on Boston-area data, and is subject to modification based on geographic location.

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. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees