Clinical Pharmacist: Utilization & Formulary Lead

WellSense Health Plan; Boston, Northern (MA, KY); Hybrid; USD 89.000 - 129.000; Vollzeit

Zusammenfassung

WellSense Health Plan is a nonprofit health plan serving MA and NH. The Clinical Pharmacist I role reports to the Manager of Pharmacy Services and focuses on pharmacy utilization management, including prior authorizations and PBM coordination with the formulary committee. It may also involve MTM and case reviews.

The ideal candidate is MA-licensed with 1–2 years of clinical experience, strong drug knowledge, and solid communication skills; eligibility for MTM and on-call work may apply.

Qualifikationen

• Massachusetts pharmacist license required.
• Bachelor of Pharmacy degree required.
• Pharmacy & Therapeutics Committee experience preferred.
• Doctor of Pharmacy degree preferred.

Aufgaben

• Review PA decisions for benefits, quality and necessity.
• Evaluate PA requests and ensure UM turnaround times.
• Ensure programs meet regulatory standards and laws.
• Research new drugs and recommend usage guidelines.
• Collaborate with PBM to identify cost savings and quality.
• Present data to the Pharmacy and Therapeutics Committee.
• Conduct medication reconciliation outreach to care members.

Kenntnisse

Pharmacology knowledge

Data analysis

Microsoft Office

Written and verbal communication

Care management

Ausbildung

Massachusetts Pharmacist license

Bachelor of Pharmacy

Pharmacy & Therapeutics Committee experience preferred

Doctor of Pharmacy preferred

Jobbeschreibung

WellSense Health Plan is a nonprofit health plan serving MA and NH. The Clinical Pharmacist I role reports to the Manager of Pharmacy Services and focuses on pharmacy utilization management, including prior authorizations and PBM coordination with the formulary committee. It may also involve MTM and case reviews.

The ideal candidate is MA-licensed with 1–2 years of clinical experience, strong drug knowledge, and solid communication skills; eligibility for MTM and on-call work may apply.