Clinical Pharmacist II Formulary 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 Director of Clinical Pharmacy, the Formulary Strategy Clinical Pharmacist is primarily responsible for oversight and management of the Plan's formularies for Medicaid and Commercial lines of business. The Formulary Strategy Clinical Pharmacist, under the supervision of the Director is also responsible for utilizing broad understanding of managed care and PBM knowledge to develop, and/or implement strategies and programs to mitigate cost trend and improve health outcomes. The Formulary Strategy Clinical Pharmacist work assignments involve conducting in-depth data analysis on drug utilization trends to evaluate and inform formulary strategies.

Our Investment in You:

* Full-time remote work

* Competitive salaries

* Excellent benefits

Key Functions/Responsibilities:

• Supports programs and clinical best practices with the objective of improving health outcomes, preventing hospital readmissions, improving member safety and reducing medical errors, and promoting health and wellness activities, where appropriate.
• Participate in the development of formulary management strategies related to specific drug coverage, step therapy protocols, quantity limits, and prior authorization guidelines
• Recommend strategic placement of existing or new drugs on the formulary to maximize benefits based on market trends, rebate opportunities and or clinical guidelines.
• Produce and analyze pharmacy cost trends and support pharmacy benefit design in collaboration with finance and actuarial teams and the PBM partner.
• Supports trend management by conducting analysis of drug spend, utilization, and/or approval scenarios for drugs managed on both the pharmacy and medical benefit
• Develops communications to be shared with senior leadership.
• Act as a resource for drug information and Pharmacy business support for key internal and external stakeholders
• Work with rest of Formulary Management team to coordinate the activities of the Plan's Pharmacy and Therapeutics Committee including clinical and financial reviews of individual drugs, drug classes, formulary development, and development of clinical policies and related metrics.
• Present strategies to decrease pharmacy costs to ACO partners and assist in provider detailing strategies to successfully implement recommendations.
• Leads effort in marketing and pharmacy-related member and provider communication materials.
• Assist in the development and maintenance of quality improvement projects, quality metrics, and quality outcome measurements
• Makes decisions on moderately complex to complex issues regarding technical approach for project components, and exercises considerable latitude in determining objectives and approaches to assignments.
• Regular and reliable attendance is an essential function of the position.

Supervision Exercised:

* N/A

Supervision Received:

* General supervision received bi-weekly.

Qualifications:

Education Required:

• Bachelor of Science in Pharmacy.

Education Preferred:

* Doctor of Pharmacy.

* Residency training or similar pharmacy experience.

Experience Required:

* 3+ years of pharmacy experience

* Knowledge of formulary utilization management practices

Experience Preferred/Desirable:

* Managed care or PBM experience highly preferred

* Pharmacy & Therapeutics Committee experience

* Prior strategy experience, with experience developing and launching complex programs in a cross-functional environment OR prior finance experience

* Project management experience or certification

Required Licensure, Certification or Conditions of Employment:

* Successful completion of pre-employment background check

* Current unrestricted licensure as a pharmacist in the Commonwealth of Massachusetts

Competencies, Skills, and Attributes:

• Strong oral and written communication skills along with the ability to distill complex analysis and recommendations into succinct, persuasive executive presentations
• Strong interpersonal skills and ability to interact within all levels of the organization as well as with external contacts.
• Able to work in a fast paced environment; ability to multi-task and manage multiple high priority projects simultaneously and prioritize to meet key deadlines without frequent formal check-in's
• Strong quantitative analysis and critical reasoning skills; ability to quickly break down complex problems and support findings with data.
• Passionate about contributing to an organization focused on continuously improving consumer experiences
• Ability to perform in an environment with changing priorities

Working Conditions and Physical Effort:

• Work is normally performed remotely or in a typical interior/office work environment.
• No or very limited physical effort required. No or very limited exposure to physical risk.
• Occasional travel (<5%) may be required.
• Fast paced office environment.

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