Job Description

Bring your strengths to Wellmark as a Clinical Pharmacist – Medicare Advantage on a growing Pharmacy team!

About the role: As a Clinical Pharmacist focused on Medicare Advantage (MA) support, you'll be responsible for supporting the management of Wellmark’s clinical strategies to strengthen Wellmark Medical and Pharmacy Drug Programs. You will serve as a drug information and clinical resource for Wellmark’s MA provider network team, vendors and joint venture partners to support Medicare Stars ratings and total cost of care. In collaboration with the Health and Pharmacy Services team and other Wellmark stakeholders, you will be responsible for the development and maintenance of evidence-based policies, clinical drug programs, and formulary management to improve quality and affordability outcomes within Wellmark’s MA program.

About you: You have diverse clinical pharmacy experience and are excited about the opportunity to bring your skills to a health plan!

You are passionate about positively impacting the health care system and doing what is right for our members. You are highly collaborative by nature and feel teamwork is essential for success. While you are skilled in collaborating with various stakeholders, you are also a self-starter and appreciate the balance of working autonomously to reach a goal. You are curious and thrive when you can use evidence-based research to drive decisions. You have strong consultation and communication skills that lead you to excel in partnering with the right people to develop creative solutions. You aren’t afraid to present insights to various audiences and are skilled in adapting your communication approach. You are experienced in clinical appeal reviews and communicating actionable insights of your reviews. You aren’t afraid to learn and take on something new – this excites you! Top candidates will have managed-care pharmacy experience and/or Medicare Advantage experience, with knowledge of CMS measures and MA regulations.

If this sounds like you, consider applying to our Clinical Pharmacist - Medicare Advantage opening today!

This position will work a hybrid schedule of at least 3 days in a Wellmark office, with 2 days remote option.

Qualifications

Required Education: Bachelor's Degree in Pharmacy OR PharmD

Required Licensure: An active and unrestricted Pharmacy license in Iowa or South Dakota (individual must be licensed in the state in which they reside) is required within 6 months from date of hire.

Additional Required Qualifications:

• 3+ years of managed care pharmacy or pharmacy residency program experience. Broad understanding of the health care delivery system, managed care and pharmacy benefit management systems, plan design and overall operations.
• Ability to make effective evidence-based decisions. Strong analytical, problem solving, and critical thinking skills.
• Excellent written and verbal communication skills. Ability to effectively articulate complex information across all levels of an organization. Strong presentation skills.
• Strong consulting and interpersonal skills to quickly build rapport, credibility, and collaborative partnerships with clinical peers, leaders, and stakeholders.
• Proficient in Microsoft Office & intermediate Excel skills – e.g., pivot tables, trend analysis, formulas.
• Strong knowledge of applicable rules, regulations, and guidelines, and maintain awareness of implications to pharmacy.
• Strong organization and prioritization skills. Ability to manage multiple projects simultaneously and consistently meet deadlines.
• Self-starter who can work well independently and as a member of a cross-functional team. Proven ability to work collaboratively with others.
• Requires Active and Unrestricted Pharmacy License in a state within the United States

Preferred Qualifications:

• Coaching/mentoring experience.
• Experience partnering with sales or account management preferred.

Additional Information

What you will do as a Clinical Pharmacist - Medicare Advantage:

a. Develop and implement clinical pharmacy programs to promote quality and cost-effective drug use. Provide clinical consulting services to internal and external stakeholders and provide clinical information and education.

b. Support medical management and clinical pharmacy initiatives of Wellmark in support of commercial and exchange lines of business through research, analyses, and administration of clinical drug utilization management programs such as DUR and formulary/non-formulary management.

c. Prepare and present therapeutic class reviews and drug monograph information to the Wellmark Pharmacy and Therapeutics Committee.

d. Research and synthesize detailed clinical data related to medications and drug therapies and develop evidence-based clinical programs for both pharmacy and medical benefits.

e. Develop and coordinate appropriate drug therapy interventions that demonstrate quality improvement, reduction in the cost of care, and improved outcomes. Actively identify and make recommendations regarding ideas to improve the quality effectiveness and efficiency of pharmacy services offered by the health plan. Make recommendations to improve medication regimens as appropriate.

f. Direct and support internal ad hoc pharmacy management projects, as well as projects with the contracted pharmacy benefit manager, as needed.

g. Evaluate, prepare, and present therapeutic class reviews, drug monograph information, and recommendations to the Wellmark Pharmacy and Therapeutics (P&T) Committee and Formulary Assessment Committee.

h. Evaluate cost effectiveness, rebate proposals and distribution channels and make recommendations to the Formulary Assessment Committee for formulary additions or changes that support Wellmark's goal of providing access to the most comprehensive and cost- effective formulary options.

i. Perform clinical review of medication appeal requests. Utilizes clinical experience and skills in a collaborative process to apply the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render appropriate coverage determination.

j. Serve as a clinical resource to other physicians, nurses, and other internal stakeholders on areas such as prospective, concurrent, and retrospective DURs, drug related fraud, waste, and abuse cases, and provide clinical support for therapeutic interventions.

k. In partnership with Marketing and Communications Team, prepare and communicate information to network providers.

l. Comply with regulatory standards, accreditation standards and internal guidelines, remain current and consistent with the standard pertinent to pharmaceuticals.

m. 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 atcareers@wellmark.com

Please inform us if you meet the definition of a "Covered DoD official".