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Wellmark Blue Cross Blue Shield Clinical Pharmacist in Des Moines, Iowa

Job Summary

Help us lead change and transform Wellmark's business

The health care industry is changing, and Wellmark is working to help change it for the better. We recognize that our members deserve health care with a focus on quality. We also recognize that health care is complex. We’ve embarked on a journey to support our members use and navigate the health care system in order to help them make clear, informed decisions, and we’re also ensuring that we take a team-centric approach when working with and in support of our members. The work that our diverse business and care teams are doing in collaboration with our health care partners will create these changes, all while working to minimize health care costs.

Bring your strengths to Wellmark as a Clinical Pharmacist

As Clinical Pharmacist, you’ll be responsible for the implementation and ongoing maintenance of Wellmark's diverse formulary portfolio including closed, open, and value based formulary designs. You'll develop clinically and ethically based content for drug coverage programs in support of prior authorization, quantity limits, step therapy and medical policy programs for Wellmark.

Diverse pharmacy experience, a passion for positively impacting the health care system, and a highly collaborative sense of teamwork are essential.Our strongest candidates are curious, skilled at uncovering needs and consulting, and partnering with the right people to develop creative solutions.

**Work from home order: The effects of COVID-19 have moved our employees to a work from home environment. This role will start out fully remote but will be expected to work from our Des Moines, Iowa office upon our return. The time in which we expect to return to our office is undetermined but will take place when it is safe to do so.

Qualifications

Required:

  • 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 health care 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 presentation skills.

  • 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 – e.g., 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.

  • Requires Active and Unrestricted Pharmacy License in a state within the United States

Preferred:

  • Coaching/mentoring experience.

  • Experience partnering with sales or account management preferred.

JOB ACCOUNTABILITIES

a. In collaboration and partnership with the Pharmaeconomist, develop and implement pharmacy programs to promote quality and cost effective drug use. Provides clinical consulting services to client and implements clinical information and education programs.b. Support core clinical programs such as DUR and formulary/nonformulary management. Will researches and synthesizes detailed clinical data related to pharmaceuticals. Prepares and presents therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee.c. Conduct research on medications and drug therapies and develop evidence based prior authorization criteria for pharmacy benefits. Review escalated prior authorizations and performs necessary research to determine medical necessity and appropriate coverage.d. Develop and coordinate appropriate drug therapy interventions that demonstrate quality improvement, reduction in the cost of care, and improved outcomes. Actively identify and make recommendations regarding ideas to improve the quality effectiveness and efficiency of pharmacy services offered by the health plan.e. Work collaboratively with pharmacists, pharmacy technicians and physicians to meet the goals and objectives of the pharmacy program. Direct and support internal ad hoc pharmacy management projects, as well as projects with the contracted pharmacy benefit manager, as needed.f. Evaluate new drug therapies and pharmacogenomics and develops written drug evaluations to be reviewed by Wellmark's P&T Committee, Formulary Planning Committees and/or Medical/Pharmacy Policy team.g. Evaluate cost effectiveness, rebate proposals and distribution channels and make recommendations to the Formulary Planning Committee for formulary additions or changes that support Wellmark's goal of providing access to the most comprehensive and cost effective formulary options.h. Present clinical evidence regarding new drug safety and efficacy to internal and external stakeholders.i. Performs clinical review of medication appeal requests. Utilizes clinical experience and skills in a collaborative process to apply the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render appropriate coverage determination.j. Serves as a clinical resource to other physicians and nurses on areas such as prospective, concurrent and retrospective DURs, and provides dosage conversion and clinical support for therapeutic interventions. Prepares information for network physicians. Processes review prior authorization requests for nonformulary medications for clinical appropriateness. Make recommendations to physicians to improve medication regimens as appropriate. Comply with regulatory standards, accreditation standards and internal guidelines, remain current and consistent with the standard pertinent to pharmaceuticals.k. Other duties as assigned.

LocationUS-IA-Des Moines

Job ID214646

CategoryClinical/Provider Support

Requires Non-Compete?Yes

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