Clinical Pharmacist Ii Formulary Management

3+ years

Not Disclosed

Remote, USA

Not Disclosed Dec. 5, 2024

Job Description

Job Type: Full Time Remote Education: B.Sc./ M.Sc./ M.Pharm/ B.Pharm/ Life Sciences/pharm.D Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

Clinical Pharmacist II – Formulary Management
Remote (United States)

About WellSense Health Plan:
WellSense Health Plan is a nonprofit organization serving over 740,000 members across Massachusetts and New Hampshire through Medicare, Medicaid, and Individual & Family plans. With a history of 25+ years, we are committed to providing health plans and services that meet diverse member needs.

Job Summary:
The Clinical Pharmacist II, Formulary Management is responsible for overseeing and managing formularies for Medicaid and Commercial lines of business. Reporting to the Manager of Clinical Pharmacy, this role includes developing formulary strategies, optimizing drug placements, supporting clinical initiatives, and ensuring compliance with regulatory and contractual requirements.

Key Responsibilities:

Develop and oversee formulary strategies, including step therapy protocols, prior authorization guidelines, and quantity limits.
Analyze pharmacy cost trends and collaborate with finance, actuarial teams, and PBM partners.
Review and ensure formulary and clinical policy compliance with NCQA and other regulatory guidelines.
Coordinate Pharmacy and Therapeutics Committee activities, including drug reviews and formulary development.
Present strategies to reduce pharmacy costs and support provider detailing.
Maintain up-to-date clinical pharmacy materials, quality improvement projects, and website content.
Ensure utilization management programs align with state, contractual, and regulatory standards.

Qualifications:

Education:
- Bachelor of Science in Pharmacy (required).
- Doctor of Pharmacy (preferred).
- Residency training or BPS certification in Pharmacotherapy (preferred).
Experience:
- Minimum of 3+ years in managed care pharmacy.
- Pharmacy & Therapeutics Committee experience (preferred: 5+ years in managed care).
Licensure:
- Current unrestricted pharmacist license in any U.S. state or territory.

Skills & Competencies:

Extensive knowledge of drug products, therapeutics, pharmacokinetics, and disease states.
Strong communication and presentation skills.
Proficient in Microsoft Office, including PowerPoint, Excel, and Word.
Effective organizational and multitasking abilities in fast-paced environments.
Strong analytical and problem-solving skills.

Why Join WellSense?

Remote Work Flexibility: Full-time remote opportunities.
Competitive Benefits: Attractive salary and benefits package.
Diversity & Inclusion: A workplace that values and fosters inclusion.

Working Conditions:

Office-based work with minimal physical effort.
Occasional travel (<5%).

Apply Today:
Join our dedicated team committed to improving healthcare outcomes for all. Visit WellSense Careers to apply.

Equal Opportunity Employer:
WellSense is an equal-opportunity employer. We participate in the E-Verify program to ensure employment eligibility.

Beware of Employment Scams:
Be vigilant of employment scams. WellSense only accepts applications through our official website. For tips on identifying scams, visit the FTC website.

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