Description
Job Summary
Help us lead change and transform the member experience
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're embarking on a journey to help our members navigate and use the 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.
Use your strengths as a Clinical Pharmacist - Specialty Drug Program
In this non-traditional pharmacy setting, you will be responsible for supporting clinical strategies to strengthen Medical and Pharmacy Specialty Drug Programs and managing specialty cost of care. You'll develop core clinical programs such as formulary management, drug utilization review, prior authorization, quantity limits, step therapy, medical policy programs, and specialty pharmacy management. Timely monitoring of program effectiveness through transparent reporting of measurable outcomes will be key. You will Innovate by applying relevant industry best practices and/or develop novel approaches to achieve program goals. In collaboration with the Health and Pharmacy Services team, other Wellmark stakeholders, and Wellmark's P&T committee, you will be responsible for the development and maintenance of evidence-based policies to improve quality and affordability outcomes.
Ideal candidates will have a strong interest in population health management and are masters at problem solving and critical thinking. They have the knowledge to review evidence-based research, interpret and present data to inform decisions, and contribute to the overall growth and operations of the specialty pharmacy program. They possess strong organization and prioritization skills and thrive in a fast paced environment where things are rapidly changing and evolving.
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.
* 5+ years of managed care pharmacy (PBM or Health Plan), completion of PGY-2 Oncology residency, 3+ years of oncology experience, or 3+ years of specialty pharmacy experience; or any combination of education and experience, which would provide an equivalent background.
* Excellent analytical, problem solving, and critical thinking skills. Ability to make effective evidence-based decisions.
* Advanced knowledge of medical literature retrieval and evaluation.
* 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.
* Continually expand pharmacy industry knowledge and ability to understand the clinical landscape, including impacts to programs/ services.
* 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.
* Requires Board Certification in Oncology (BCOP) from the Board of Pharmacy Specialties (Or eligible to sit for the exam and attain certification within 2 years of hire).
Preferred:
* Board Certification in Oncology (BCOP) from the Board of Pharmacy Specialties or eligible to sit for the exam and attain certification within 2 years of hire preferred.
* Specialty pharmacy cost of care strategy experience preferred.
* Oncology clinical program implementation experience preferred.
* Experience with pharmacy data and analytics preferred.
* Experience with medical claims and medical data preferred.
* Experience in the management of oncology drugs.
* Experience with developing and implementing pharmacy quality & cost savings programs.
* Broad understanding of the health care delivery system, managed care and pharmacy benefit manage.
JOB ACCOUNTABILITIES
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.a. Design and develop a longterm strategy for Wellmarks specialty pharmacy program to support appropriate use of specialty drugs and measurably improve quality and affordability in both the medical and pharmacy benefit. Consult and engage with pharmacy team in an ongoing manner to seek input and secure buyin.b. Monitor effectiveness of existing and new specialty drug programs and innovate and apply additional interventions to meet or exceed measurable quality and affordability goals.c. Support core specialty clinical programs. Research and synthesize detailed clinical data related to specialty pharmaceuticals, including oncology drugs, to identify opportunities or impact.d. Provide clinical consulting services and implement clinical information and education programs.e. Analyze specialty drug and oncology drug spend and trend data and create mitigating strategies in response to trend.f. Monitor specialty drug pipeline and evaluate the impact of new therapies.g. Provide clinical guidance and support to various departments and address clinical related questions. Serve as a subject matter expert to help drive more proactive interventions of clinical and pharmacy trends.h. Prepare and present therapeutic class reviews, drug monograph information, and recommendations for formulary management, utilization management, etc., for emerging therapies to the Pharmacy and Therapeutics Committee.i. Work collaboratively with pharmacists and providers 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.j. Provide insights and advise internal and external stakeholders on new and upcoming advances in pharmacy and the resulting impacts.k. Manage clinical program implementations and ensure compliance with regulatory standards and accreditation standards.l. Other areas of responsibilities include, specialty benefit design strategies, strengthening the specialty value proposition and presenting to internal and external stakeholders as requested. m. Other duties as assigned.
