Managed Care Pharmacist – Managed Care/PBM

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

👻 Ghost score 10%

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WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 Description

• Support all aspects of Pharmacy Benefit Manager (PBM) implementation • Broker communication and ensure execution of desired plan benefit design • Collaborate with stakeholders, clients, and the PBM on issue resolution • Educate clients and key stakeholders on pharmacy benefits • Assist in optimizing clinical outcomes while reducing pharmacy spend • Support quality assurance activities for utilization management reviews • Monitor and assess clinical program outcomes • Develop and implement clinical and quality program designs for the pharmacy benefit • Evaluate clinical and performance metric reporting • Assess medication utilization • Oversee formulary administration and pharmacy benefit development • Interpret benefits and profile plan cost and utilization data • Manage provider relations • Report pharmacy measure performance and gap closure to health plan leadership • Design, implement, track, report, and evaluate PBM clinical program initiatives • Identify cost-saving and quality improvement strategies • Perform data-driven analyses of clinical program outcomes • Liaise with the PBM and assist with oversight of clinical and quality programs • Conduct quality assurance analyses of utilization management reviews • Participate in client, external partner, clinical committee, and cross-functional workgroup meetings • Provide guidance to pharmacy services staff • Manage vendor relationships related to Part D Stars measure performance • Ensure regulatory compliance and reporting • Monitor processing issues and identify opportunities for improvement or education • Monitor PBM adherence to CMS metrics and key performance indicators • Reconcile and report Drug Management Program data • Resolve clinical eligibility flag discrepancies from PBM PDE rejections • Support pharmacy and formulary directory development using CMS guidance • Liaise between internal departments and PBM Client Account Executives

🎯 Requirements

• Current and unrestricted license to practice pharmacy issued by state of residence • Three (3) years of experience as a pharmacist in a managed care setting • Ability to stand and walk short distances for eight or more hours • Frequent bending, stooping or stretching • Ability to lift 30 pounds and push 50 pounds • Ability to work under stressful working conditions • Ability to handle and maintain confidential information • Ability to work independently or cooperatively as a team member • Experience with regulatory and accreditation standards • Ability to work in a fast-paced and rapidly changing environment • Extensive working knowledge of Microsoft Office applications (Excel and Access) • Experience with audits

🏖️ Benefits

• Full-time position • Exempt status • 40 scheduled weekly hours • Reasonable accommodations for individuals with disabilities • Some travel to offsite meetings may be required