Clinical Pharmacist I - UM & Formulary Strategy (Remote)

BMC HealthNet Plan; United States; Remote; USD 89,000 - 129,000; Full time

Benefits offered by this job

Full-time remote work

Competitive salaries

Job summary

WellSense Health Plan is seeking a Clinical Pharmacist I to lead pharmacy utilization management, review prior authorization requests, and coordinate PBM activities. The role supports MTM and case reviews as needed, with opportunities to participate in care management.

The position emphasizes compliance with standards, collaboration with committees, and ongoing drug use research to optimize patient care and cost efficiency.

Qualifications

• Massachusetts pharmacist license required for practice.
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• Bachelor of Pharmacy degree required.
• Doctor of Pharmacy degree preferred.
• 1-2 years of clinical experience in managed care settings.
• Pharmacy & Therapeutics Committee experience preferred.

Responsibilities

• Approve prior authorization decisions in line with benefits and medical necessity.
• Evaluate and document PA requests within UM turnaround times.
• Ensure compliance with industry, regulatory, and contractual standards.
• Research new drugs and provide drug-use recommendations.
• Collaborate with PBM to identify cost savings and quality improvement.
• Prepare clinical/financial data for the Pharmacy & Therapeutics Committee.
• Conduct medication reconciliation outreach to care management members.

Skills

Pharmacology knowledge

Data interpretation

Communication skills

Attention to detail

Education

Massachusetts pharmacist license

Bachelor of Pharmacy

Pharmacy & Therapeutics Committee experience preferred

Doctor of Pharmacy preferred

Tools

Microsoft Office

Job description

WellSense Health Plan is seeking a Clinical Pharmacist I to lead pharmacy utilization management, review prior authorization requests, and coordinate PBM activities. The role supports MTM and case reviews as needed, with opportunities to participate in care management.

The position emphasizes compliance with standards, collaboration with committees, and ongoing drug use research to optimize patient care and cost efficiency.