Remote Clinical Pharmacist I - Utilization & Formulary

Wellsense-Health-Plan; Boston (MA); Hybrid; USD 89,000 - 129,000; Full time

Benefits offered by this job

Full-time remote work

Competitive salaries

Job summary

WellSense Health Plan seeks a Clinical Pharmacist I to lead pharmacy utilization management, review prior authorizations, and coordinate PBM and Pharmacy & Therapeutics activities. This full-time role supports care management programs and may include MTM and case reviews.

Responsibilities include evaluating PA requests, ensuring compliance with standards, and collaborating with the PBM to enhance cost savings and quality. Massachusetts licensure is required.

Qualifications

• Licensed in Massachusetts as a Pharmacist.
• Bachelor of Pharmacy degree.
• Pharmacy & Therapeutics Committee experience preferred.
• Doctor of Pharmacy degree preferred.

Responsibilities

• Ensure PA decisions align with benefits, quality of care and medical necessity.
• Evaluate, document and meet PA turnaround times.
• Ensure programs meet industry, regulatory and contractual standards.
• Research new drugs or new uses and make recommendations.
• Collaborate with PBM to identify cost-saving opportunities and quality improvements.
• Gather clinical and financial data for PB&T Committee presentations.
• Participate on clinical committees as needed.
• Conduct medication reconciliation outreach calls to members.

Skills

Pharmacotherapy knowledge

Microsoft Office

Data analysis

Verbal & written communication

Education

Massachusetts Pharmacist License

Bachelor of Pharmacy

Doctor of Pharmacy preferred

Tools

PBM coordination systems

Job description

WellSense Health Plan seeks a Clinical Pharmacist I to lead pharmacy utilization management, review prior authorizations, and coordinate PBM and Pharmacy & Therapeutics activities. This full-time role supports care management programs and may include MTM and case reviews.

Responsibilities include evaluating PA requests, ensuring compliance with standards, and collaborating with the PBM to enhance cost savings and quality. Massachusetts licensure is required.