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Clinical Pharmacist

2 months ago

Des Moines, Iowa, United States Wellmark Blue Cross and Blue Shield Full time
About the Role

We are seeking a highly skilled Clinical Pharmacist to join our growing Pharmacy team at Wellmark Blue Cross and Blue Shield. As a Clinical Pharmacist, you will play a critical role in supporting the management of our clinical strategies to strengthen our Medical and Pharmacy Drug Programs.

About You

We are looking for a talented and experienced Clinical Pharmacist who is passionate about positively impacting the healthcare system and doing what is right for our members. You will have diverse clinical pharmacy experience and be excited about the opportunity to bring your skills to a health plan. You will be highly collaborative by nature and feel that teamwork is essential for success.

Responsibilities
  • 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.
  • 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.
  • Prepare and present therapeutic class reviews and drug monograph information to the Wellmark Pharmacy and Therapeutics Committee.
  • Research and synthesize detailed clinical data related to medications and drug therapies and develop evidence-based clinical programs for both pharmacy and medical benefits.
  • Develop and coordinate appropriate drug therapy interventions that demonstrate quality improvement, reduction in the cost of care, and improved outcomes.
  • Direct and support internal ad hoc pharmacy management projects, as well as projects with the contracted pharmacy benefit manager, as needed.
  • 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.
  • 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.
  • Perform clinical review of medication appeal requests.
  • 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.
  • In partnership with Marketing and Communications Team, prepare and communicate information to network providers.
  • Comply with regulatory standards, accreditation standards and internal guidelines, remain current and consistent with the standard pertinent to pharmaceuticals.
Requirements
  • Bachelor's Degree in Pharmacy OR PharmD.
  • 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.
  • 3+ years of managed care pharmacy or pharmacy residency program experience.
  • Broad understanding of the healthcare 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 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 –, 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.
Preferred Qualifications
  • Coaching/mentoring experience.
  • Experience partnering with sales or account management preferred.
Additional Information

This job requires a non-compete agreement.