Pharmacist

2 weeks ago

Menasha, Wisconsin, United States Network Health Plan (Wisconsin) Full time

Network Health is seeking a PharmacistThis individual is responsible for providing clinical support for Network Health's pharmacy, quality, compliance and health management efforts. This may include Case Management, Disease Management, Medication Therapy Management, Drug Utilization Review and creation of Clinical Programs to outcomes and cost effective drug therapy. The incumbent in this role assists in the development and evaluation of the plan formulary and benefit designs, and reports and presents such information as part of the Network Health P&T Committee. The Pharmacist collaborates with other Network Health departments to optimize regulatory compliance and Quality Measures such as NCQA HEDIS. In addition, the Pharmacist assists in outreach efforts for provider education and provider detailing.

Job Responsibilities:

  • Assist with Commercial compliance work plan over site
  • PBM follow up regarding claim audits (benefit change forms, member, reimbursement/ recoupments, follow up audits to monitor effectuation of changes)
  • Participates in case management, disease management and poly-pharmacy for Network Health patients with extraordinary high drug costs, including related services
  • Assists in providing physician education in areas of potential improvement i.e., create articles for pharmacy newsletter for Network Health providers, speak to medical departments regarding drug issues, speak to individual providers regarding drug issues including those for individual Network Health members, participate in appropriate quality improvement projects, etc.
  • Assist with Concurrent DUR, Retrospective DUR, and MTM programs.
  • Assist with formulary management and identifying UM criteria
  • Performs other duties and responsibilities as assigned.
Job Requirements:
  • Bachelor of Science in Pharmacy. Doctorate of Pharmacy preferred.
  • A minimum of 3 years clinical experience.
  • Residency/fellowship preferred. Managed care experience desirable.
  • Prefer experience in at least one of the following areas:
    • Medication Therapy Management Programs
    • Long Term Care Pharmacy consulting or
    • Decentralized hospital pharmacy services.
Credential/Licensure Required:
  • Current Pharmacist licensure without restriction by the State of Wisconsin Pharmacy Examining Board.
  • Valid Driver's License
*Travel to the Menasha (corporate) office will be required if reside outside of the Fox Cities.

We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce.

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