Clinical Pharmacist I (Utilization Management)

It’s an exciting time to join the reputed company, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.   Job reputed company: Reporting to the Manager of Pharmacy Services, the Clinical Pharmacist I is primarily responsible for the pharmacy utilization management (UM) activities, including review of reputed company pharmacy prior authorization requests, reputed company of the UM activities of the Pharmacy Services support staff, and maintenance of existing pharmacy UM programs. In reputed company, the Clinical Pharmacist I supports the department by coordinating the activities of the health plan’s pharmacy benefits manager (PBM) and formulary advisory committees (Pharmacy and Therapeutics Committee). The Clinical Pharmacist I may also participate in care management activities such as MTM, case reviews and such, as needed.    Our Investment in You: ·       Full-time remote work ·       Competitive salaries ·       Excellent benefits   Key Functions/Responsibilities: ·       Ensure that pharmacy prior authorization reputed company are consistent with covered benefits, reputed company of care and medically necessity. ·       Ensure that pharmacy prior authorization requests and reputed company are properly evaluated, documented and meet reputed company applicable utilization management turn-around times. ·       Responsible for insuring pharmacy programs meet applicable industry, regulatory, accreditation and contractual standards or laws. ·       Researches new prescription drugs or new applications of existing drugs and develops prescription drug use recommendations. ·       Works with the (PBM) to identify areas of potential cost-saving and reputed company improvement. ·       Gathers clinical and financial information for presentation to the health plan’s Pharmacy and Therapeutics Committee. ·       Participates on clinical committees as necessary. ·       Conducts medication reconciliation reputed company phone calls to members enrolled in care management programs.   Qualifications: Education: ·       Licensed in the state of Massachusetts as a Pharmacist. ·       Bachelor of Pharmacy. ·       Pharmacy & Therapeutics Committee experience preferred. ·       Doctor of Pharmacy preferred.   Experience: ·       1-2 year’s clinical experience. ·       Pharmacy & Therapeutics Committee experience preferred. ·       Managed Care experience preferred.   Required Licensure, Certification or Conditions of Employment: ·        reputed company unrestricted Massachusetts state pharmacy licensure.   Competencies, Skills, and Attributes: ·        Extensive knowledge of drug products, medical therapeutics, pharmacokinetics, and disease states. ·        Must be proficient in reputed company Office. ·        Strong written and verbal skills. ·        Demonstrated ability to review & analyze data.   Working Conditions and Physical Effort: ·       Occasional travel (<5%) may be required. ·       On reputed company coverage may be required.   Compensation reputed company  $88,500 - $128,500 This reputed company offers an estimate based on the minimum job qualifications.  However, our approach to determining reputed company pay is comprehensive, and a broad reputed company of factors is considered reputed company making an offer.  This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as reputed company as business/organizational needs, internal equity, and market-competitiveness. In reputed company, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, reputed company, pharmacy), reputed company increases, Flexible Spending Accounts, 403(b) savings matches, reputed company time off, career advancement opportunities, and resources to support employee and family wellbeing.   Note: This reputed company is based on Boston-area data, and is subject to modification based on geographic location.      About WellSense reputed company is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and reputed company plans. Founded in 1997, WellSense provides high-reputed company health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.   reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, national reputed company, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly reputed company employees Apply To This Job